Phantom Sensation-Underreported Sensory Outcome Following Intercostal-to-Musculocutaneous Nerve Transfer.

Abstract

Intercostal-to-musculocutaneous nerve transfer is commonly performed in patients with brachial plexus avulsion injuries. As techniques have improved since its inception in 1963, most patients now experience some level of motor function improvement of their affected arm. While motor outcomes are well described, there is a paucity of literature describing sensory outcomes. It is thus difficult to gauge surgical success with respect to sensory function, and there is a necessity to share clear expectations with patients regarding intended or unintended postoperative sensation. In this case report, we describe an unintended sensory outcome of this procedure. Three years after the operation, our patient experiences a "phantom sensation" on his chest when he is touched on the lateral forearm in the distribution of the lateral antebrachial cutaneous nerve. This outcome can be explained with review of the anatomy before and after the operation. The persistence of this adverse outcome suggests limitations in sensory cortical neuroplasticity. It is important to be aware of potential sensory complications in intercostal-to-musculocutaneous nerve transfer. Although this complication is known, it is often overlooked and underreported. Complications such as this should be emphasized in order to set expectations for patients and guide evaluation of sensory outcomes in a future study.