Pain along the medial aspect of the arm in a post-mastectomy patient is due to?
Correct Answer: Intercostobrachial neuralgia
Description: POST MASTECTOMY PAIN
The breast, axilla and upper are innervated by a variety of nerves; the lateral cutaneous branch of T2 (intercostobrachial nerve), T3 and T4 provide innervation to the anterior chest wall and upper back, the torso and nipple.
Sympathetic innervation of the cutaneous structures of the breast is provided by the medial and lateral branches of the ventral ramus of 3rd to 6th intercostal nerves.
While both nociceptive pain (due to damage of muscles and ligaments) and neuropathic pain can occur after surgery for breast cancer, neuropathic pain is more likely to persist after wound healing has occurred.
Four pain syndromes have been distinguished
1. Phantom breast pain is a painful (often knife-like or shooting) sensation that the removed breast is still present.
2. Intercostobrachial neuralgia: usually known as post-mastectomy pain syndrome (PMP). Consists of pain in the axilla, medial upper arm and anterior chest wall and is often caused by nerve damage during axillary node dissection
3. Neuroma pain: can occur from scars from either mastectomy or lumpectomy but is more common if surgery is followed by radiotherapy.
4. Other nerve injury pain: can occur even if the intercostobrachial nerve is spared and is more common in breast reconstruction and implants.
In Jung et also review, there were 21 studies with follow-up periods from 1-96 months (one study of 210 months), which revealed the following widely varying ranges of prevalence estimates:
Phantom breast pain 3-44 per cent
Intercostobrachial neuralgia (ICN) 16-39 per cent for all breast cancer surgery;
ICN in breast-conserving surgery 14-61 per cent
Neuroma pain 23-49 per cent.
Category:
Surgery
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