Functional capacity after peripheral nerve lesion: significance of pain syndromes

Introduction:The loss of functional capacity by peripheral nerve lesion is easy to be estimated: A certain neurologic dysfunction results in a charact eristic reduction of the former individual capacity. In contrast,the effect of accompanying pain to every-day life and working ability is not known ex actly. In this study,we compared the results of judgement in nerve lesions under the circumstances of additional pain syndromes. Methods: From January 1994 until December 1998 we saw 57 patients with peri pheral nerve lesions, part of them with an additional pain syndrome. Beside conventional neurological examination a detailed pain analysis has been do ne. Results: Lesions of the median or ulnar nerves showed regularly disturbence s in neurological functions (10/14 for the mediane nerve, 13/16 for the uln ar nerve). Astonishing is the fact, that serious pain after nerve lesion on ly occurs in cases of partial nerve lesion. We saw neuralgias in 6 patients with ulnar neuropathy, in three cases of median nerve lesions we could see severe neuralgia (causalgia we found in 3 cases of ulnar neuropathy, in 6 cases after Median Nerve lesion). Patients with a lesion of the central ple xus brachialis showed in 10 of 11 cases an additional pain syndrome. Other nerves have been affected more rarely. For the judgement of the loss of ear ning capacity we saw an additional pain related diminuition of at least 10% compared to those patients without pain problems. Conclusions: The common grading scales for peripheral nerve lesions are not suitable in cases accompanied by an additional pain syndrome. Beside a fun ctional deficit the effect of severe pain in these patients has to be estim ated. On an average, patients with addtitional pain-problems get a 10% exte nded loss of earning capacity, even more in particular cases.