To the Editor.—
The article "Functional Recovery and Orthopedic Management of Brachial Plexus Palsies" (1981;246:2467) by M. Mark Hoffer, MD, subcategorizes 15 of 37 patients with "no motor or sensory return." All experienced pain, nine in which pain was chronic and refractory to attempted therapies, including amputation and shoulder fusion. Undoubtedly these patients suffered brachial plexus avulsion and resultant deafferentation pain syndrome. Although conventional medical and surgical therapies are of little value, the contemporary technique of (spinal) dorsal root entry zone lesions relieves this central pain syndrome in more than two thirds of cases.1 It is unfortunate to discuss rehabilitation but overlook an effective treatment for this neurosurgical disorder occurring in 40% of the avulsion group.
Iacono R. Management of Brachial Plexus Palsies. JAMA. 1982;247(15):2099-2100. doi:10.1001/jama.1982.03320400019021