Three cases of referred sensation in traumatic nerve injury of the hand: implications for understanding central nervous system reorganization.

Abstract

OBJECTIVE: The aim of this observational study was to explore whether patients with traumatic peripheral nerve injury of the hand perceive referred sensations; sensations that are perceived to emanate from other areas of the body than the part being stimulated. Referred sensations have been reported following amputation, somatosensory deafferentation, local anaesthesia, stroke, brachial plexus avulsion injury, spinal cord injury and complex regional pain syndrome type 1. DESIGN: Ten patients with ulnar or median nerve injuries underwent sensory testing of the face, upper body and legs, involving light touch with a cotton swab. Patients were asked to describe the location of the stimulated site, the sensations emanating from it and any other sensations experienced. Three patients with referred sensations were identified and followed over a period of time. RESULTS: Clear and reproducible referred sensations were found in 3 out of 10 patients examined. CONCLUSION: Referred sensations were found in traumatic nerve injury, providing evidence of reorganization of the central nervous system after peripheral injury.