Postoperatieve pijn en krachtsverlies in de schouder-armregio; iatrogeen of niet?

- Four patients, one man aged 66 years and three women aged 69, 33 and 55 years, respectively, had postsurgical pain and weakness in the shoulder-arm region. Initially, a peripheral nerve lesion on a mechanical basis was suspected in all patients. However, because of the sharp pain starting after a postsurgical pain-free interval ranging from a few hours to two days, followed after some time by local muscular weakness, the diagnosis ‘neuralgic amyotrophy’ was made later. The electromyographic findings were in agreement with this diagnosis. The chronological sequence of the symptoms only became clear after targeted questioning. After 6-24 months, the strength was more or less restored. Usually, the prognosis of neuralgic amyotrophy is favourable, although full functional recovery may take two to three years and in a minority of cases recovery remains incomplete. Early diagnosis is important because of the prognostic aspects and to prevent unnecessary investigations or even surgical explorations, as well as legal claims. Therefore, not only neurologists but particularly surgeons and anaesthesiologists should be aware of this postsurgical condition.