Peripheral Nerve Injury

Injury in the lower limbs is extremely frequent in most sport activities, particularly when prolonged running and physical contact are prominent features. A major challenge is the differential diagnosis between muscle, joint and nerve lesions, although it should always be considered that combined lesions are quite frequent. In this part of the review, the most frequent nerve entrapment and traumatic

Background: Neck pain is a common musculoskeletal complaint and is often associated with shoulder or arm pain.
There is a paucity of information on effective treatment for neck and arm pain, such as radiculopathy or cervico-brachial
pain. Guidelines recommend neck mobilisation/ manipulation, exercises and advice as the treatment for neck pain, and
neck and arm pain. There are a few studies that have used neural mobilisation as the treatment for cervico-brachial pain.
Although results seem promising the studies have small sample sizes that make it difficult to draw definite conclusions.
Methods: A randomised controlled trial will be used to establish the effect of neural mobilisation on the pain, function
and quality of life of patients with cervico-brachial pain. Patients will be recruited in four physiotherapy private practices
and randomly assigned to usual care or usual care plus neural mobilisation.
Discussion: In clinical practice neural mobilisations is commonly used for cervico-brachial pain. Although study
outcomes seem promising, most studies have small participant numbers. Targeting the neural structures as part of the
management plan for a subgroup of patients with nerve mechano-sensitivity seems feasible. Patients with neuropathic
pain and psychosocial risk factors such as catastrophising, respond poorly to treatment. Although a recent study found
these patients less likely to respond to neural mobilisation, the current study will be able to assess whether neural
mobilisation has any added benefit compared to usual care. The study will contribute to the knowledge base of
treatment of patients with cervico-brachial pain. The findings of the study will be published in an appropriate journal.
Trial registration: Trial registration Number: PACTR201303000500157.
Keywords: Neck pain, Cervico-brachial pain, Neural mobilisation, Neuropathic pain, Catastrophising

To the readers of e-News Somatosens Rehab and to those who will read this article by reference, I am delighted to count you among this growing network and to notice that we share a common interest, namely the management of neuropathic pain and their symptoms via somatosensory rehabilitation.

Let me introduce myself. I am an occupational therapist working in a private clinic since 2014, also practicing with a physical and mental health clientele living with chronic pain.

Having a keen interest in understanding and managing pain, I completed a 2.5-year graduate certificate on chronic pain management at McGill University. Still not having satisfactory answers concerning the management of neuropathic pain after my graduation in 2018, I followed the training on somatosensory rehabilitation of pain the next year.

It was during this training that I saw great potential in the approach and came to realize that I could have used it with my past problematic cases of neuropathic pain. Unfortunately, their condition had been ignored/not treated effectively by all of the professionals in their file, due to a lack of knowledge.

"The present study aimed at investigating the time span it takes to remove a static mechanical allodynia (SMA) in humans
suffering from chronic peripheral neuropathic pain. Forty-three subjects were included in the study and, during
somatosensory rehabilitation, their SMA territory was precisely mapped. They then underwent distant vibrotactile counter
stimulation (DVCS) treatment. It was observed that, with DVCS, SMA disappeared in all cases, and was transformed into
an underlying hypoaesthesia. It was found that the ‘‘tenderness to touch’’ symptom (which is SMA) was located in the same
territory as the underlying hypoaesthesia, which was located on a part of the cutaneous territory of a partially damaged nerve.
These results demonstrate that treating patients suffering from neuropathic pain with DVCS revealed a skin territory of
denervation that was previously masked by SMA. Thus, SMA can be considered as a paradoxical painful hypoaesthesia.
Furthermore, mapping SMA is a valuable source of information for our understanding of abnormal sensory processing in
neuropathic pain patients. We conclude that the mapping of the zone of hypersensitivity on the skin in humans suffering from
chronic peripheral neuropathic pain improves diagnosis. The mapping of the zone of hypersensitivity is a tool to presume
which branch of the peripheral nerve is damaged. The location of the axonal lesions is at the periphery, while the mechanism
of pain sensitization is probably central and referred peripherally to the skin by a painful hypoaesthesia."