Recovery of upper limb motor function in tetraplegia with stellate ganglion block treatment of reflex sympathetic dystrophy: a case report.
Recovery of motor function in spinal cord injury usually does not occur beyond 2 yr from the date of injury and is rare beyond 8 yr. We present a case of a gentleman with a right C-5 motor, left T-5 motor, bilateral T-5 sensory tetraplegia, sustained after a fall in September 1985, who developed reflex sympathetic dystrophy of his right arm. This pain failed to resolve during the next 8 yr, despite conservative treatment consisting of range of motion, contrast baths, transcutaneous electrical nerve stimulation unit, and tricyclic antidepressants. Furthermore, his pain was refractory to dorsal rhizotomy in 1987. Subsequent follow-up visits documented ongoing pain and weakness of the right arm, with a stable injury pattern. Approximately 8 yr after initial injury, the patient underwent a series of eight stellate ganglion blocks, with the surprising result of improvement in Kendall graded motor function. This improvement was enough to represent a change in the motor level of spinal cord injury from C-6 to C-7, with a resultant increase in functional abilities. The improvement of motor function after stellate ganglion blocks for treatment of reflex sympathetic dystrophy is unprecedented and indicates that its aggressive treatment in patients with myelopathies may hasten motor recovery and, thus, functional gains. Physiologic explanations for this phenomenon include (1) resolution of pain inhibition, (2) improvement in disturbed microcirculation, and (3) resolution of sympathetic inhibition of mu-motor neurons via internuncial neurons.
Levy
C E
CE
Department of Physical Medicine and Rehabilitation, The Ohio State University, USA.
Lorch
F
F
D001132:Arm / Q000294:innervation*; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009407:Nerve Block; D011782:Quadriplegia / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation*; D012019:Reflex Sympathetic Dystrophy / Q000503:physiopathology* / Q000534:rehabilitation*; D013997:Time Factors