RECOGNITION AND MANAGEMENT OF UPPER EXTREMITY PAIN SYNDROMES IN THE PATIENT WITH BRAIN INJURY

Pain syndromes in the patient with traumatic brain injury (TBI) are of ten obscure and, therefore, frequently overlooked. spasticity, with re sultant joint contracture, is one of the most common causes of pain in the patient with brain injury. Missed fractures, reflex sympathetic d ystrophy (RSD), heterotopic ossification (HO), and deep venous thrombo sis (DVT) are frequent causes of upper extremity pain in patients alte r TBI. RSD in TBI has a 12% overall incidence and presents almost excl usively in the spastic upper extremity. Patients who developed RSD had lower Glasgow Coma Scale scores than the non-RSD patients. Patients w ith brain injury often display agitation, hyperalgesia, and disuse or neglect of the RSD involved extremity, In addition, these patients are often cognitively unable to vocalize complaints of pain. Undiagnosed pain syndromes such as fractures, RSD, HO, and DVT in these patients c an result in a significant delay in rehabilitation and possible loss o f the use of an otherwise functional upper extremity.