Work accident

A neuropathic syndrome after the traumatic amputation of the distal phalanx of the fifth digit secondary to a work accident with lack of responsiveness to a triple conservative therapy. An upper arm region approach for the PNS was chosen. The procedure had a favorable outcome; in fact, after one month the pain symptoms were absent (VAS 0) and the pharmacological therapy was suspended. The second case presented a patient affected by progressive CRPS type II in the sensory regions of the ulnar and median nerve in the hand, unresponsive to drug therapy. For this procedure, the PNS device was implanted in the forearm. Unfortunately, in this second case the migration of the catheter affected the effectiveness of the treatment. After examining the two cases in this paper, we changed our practice and suggest the implantation of PNS for radial, median and/or ulnar nerve stimulation in the upper arm region, which has significant advantages over the forearm region 1)


Clinical case of a physical education teacher who suffers an accident in one of her classes. The following day she is assessed at the emergency department and, after undergoing a radiological study of the cervical spine, she is diagnosed with straight cervical spine (kyphosis). She is observed again seven days later due to persistent pain but sent home with unchanged indications for rest and medication. After that her cervicobrachialgia progressively worsens, limiting her left shoulder active mobility and leading to associated muscle atrophy (in addition to a burnout syndrome). Several years after she is considered to have a total permanent disability. Finally, the authors propose that CWS should be approached according to the post-traumatic bodily injury evaluation methodology, suggesting some interventions 2)


1)
Bellini V, Baciarello M, Cascella M, Saturno F, Compagnone C, Vittori A, Bignami EG. Wireless Peripheral Nerve Stimulation for The Upper Limb: A Case Report. Int J Environ Res Public Health. 2023 Mar 3;20(5):4488. doi: 10.3390/ijerph20054488. PMID: 36901498; PMCID: PMC10001981.
2)
Costa de Almeida MJ, Almeida L, Freire Duarte M, Alvez de Matos S. Cervical Whiplash Syndrome: A Case Report of a Work Accident. Cureus. 2023 Jan 13;15(1):e33742. doi: 10.7759/cureus.33742. PMID: 36788821; PMCID: PMC9922518.
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