TY - JOUR
T1 - The anatomical relationship of the superficial radial nerve and the lateral antebrachial cutaneous nerve
T2 - A possible factor in persistent neuropathic pain
AU - Poublon, A. R.
AU - Walbeehm, E. T.
AU - Duraku, L. S.
AU - Eilers, P. H C
AU - Kerver, A. L A
AU - Kleinrensink, G. J.
AU - Coert, J. H.
PY - 2015/2
Y1 - 2015/2
N2 - The superficial branch of the radial nerve (SBRN) is known for developing neuropathic pain syndromes after trauma. These pain syndromes can be hard to treat due to the involvement of other nerves in the forearm. When a nerve is cut, the Schwann cells, and also other cells in the distal segment of the transected nerve, produce the nerve growth factor (NGF) in the entire distal segment. If two nerves overlap anatomically, similar to the lateral antebrachial cutaneous nerve (LACN) and SBRN, the increase in secretion of NGF, which is mediated by the injured nerve, results in binding to the high-affinity NGF receptor, tyrosine kinase A (TrkA). This in turn leads to possible sprouting and morphological changes of uninjured fibers, which ultimately causes neuropathic pain. The aim of this study was to map the level of overlap between the SBRN and LACN.Twenty arms (five left and 15 right) were thoroughly dissected. Using a new analysis tool called CASAM (Computer Assisted Surgical Anatomy Mapping), the course of the SBRN and LACN could be compared visually. The distance between both nerves was measured at 5-mm increments, and the number of times they intersected was documented.In 81% of measurements, the distance between the nerves was >10 mm, and in 49% the distance was even <5 mm. In 95% of the dissected arms, the SBRN and LACN intersected. On average, they intersected 2.25 times.The close (anatomical) relationship between the LACN and the SBRN can be seen as a factor in the explanation of persistent neuropathic pain in patients with traumatic or iatrogenic lesion of the SBRN or the LACN.
AB - The superficial branch of the radial nerve (SBRN) is known for developing neuropathic pain syndromes after trauma. These pain syndromes can be hard to treat due to the involvement of other nerves in the forearm. When a nerve is cut, the Schwann cells, and also other cells in the distal segment of the transected nerve, produce the nerve growth factor (NGF) in the entire distal segment. If two nerves overlap anatomically, similar to the lateral antebrachial cutaneous nerve (LACN) and SBRN, the increase in secretion of NGF, which is mediated by the injured nerve, results in binding to the high-affinity NGF receptor, tyrosine kinase A (TrkA). This in turn leads to possible sprouting and morphological changes of uninjured fibers, which ultimately causes neuropathic pain. The aim of this study was to map the level of overlap between the SBRN and LACN.Twenty arms (five left and 15 right) were thoroughly dissected. Using a new analysis tool called CASAM (Computer Assisted Surgical Anatomy Mapping), the course of the SBRN and LACN could be compared visually. The distance between both nerves was measured at 5-mm increments, and the number of times they intersected was documented.In 81% of measurements, the distance between the nerves was >10 mm, and in 49% the distance was even <5 mm. In 95% of the dissected arms, the SBRN and LACN intersected. On average, they intersected 2.25 times.The close (anatomical) relationship between the LACN and the SBRN can be seen as a factor in the explanation of persistent neuropathic pain in patients with traumatic or iatrogenic lesion of the SBRN or the LACN.
KW - cutaneous nerve
KW - LACN
KW - Neuropathic pain superficial branch of the radial nerve,
KW - SBRN lateral antebrachial
KW - Sprouting
KW - Wallerian degeneration
UR - http://www.scopus.com/inward/record.url?scp=84921535500&partnerID=8YFLogxK
U2 - 10.1016/j.bjps.2014.10.010
DO - 10.1016/j.bjps.2014.10.010
M3 - Article
C2 - 25455286
AN - SCOPUS:84921535500
SN - 1748-6815
VL - 68
SP - 237
EP - 242
JO - Journal of Plastic, Reconstructive & Aesthetic Surgery
JF - Journal of Plastic, Reconstructive & Aesthetic Surgery
IS - 2
ER -