抄録
A 26-year-old worker suffered an accident in which his right arm was caught in a machine. Although he could flex his fingers, wrist, and elbow, he was unable to extend them. Nevertheless, he was able to elevate his arm horizontally. Hypesthesia was present over the forearm, and a brachial plexus injury was suggested. He suddenly felt severe pain in the right arm one month after the injury. He then felt a stabbing or stinging sensation over his right arm. He evidenced clenching and wrenching of the elbow, and an aggravated sensation of pain irradiated centrifugally whenever his right arm or fingers were touched or moved passively. Stellate ganglion block was performed. Neurolysis of the right radial nerve, right axillary nerve block and thermocoagulation, cervical epidural block, and subarachnoid block were done. These procedures resulted in only slight or transient effects. When admitted to the neurosurgical department 20 months after the injury, his immobile arm showed pale, cold skin, hyperalgesia, and muscular atrophy accompanied by severe pain. Percutaneous electrodes were inserted in the epidural space for electrical stimulation of the spinal cord. This stimulation resulted in an increased endorphin level in the cerebrospinal fluid. The effects of this procedure lasted for 3 months, but the pain recurred. Spinal ganglia C7, C8, Thl, and Th2 were then removed. Results were excellent for 5 months of follow-up. When sympathectomy has little effect on chronic causalgia, spinal ganglionectomy is recommended.
