363 - From Thermal Burns to Burning Pain: A Case of Demyelinating Nerve Injury

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

KS

Kanwardeep Singh, MD

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Co-Author(s)

TD

Tava DeQuattro, BS

Medical Student
New York Institute of Technology College of Osteopathic Medicine
Brooklyn, New York, United States
AI

Adam Isaacson, MD

Program Director
Nassau University Medical Center
East Meadow, New York, United States
DM

Diane N. Moya, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Case Diagnosis: Demyelinating Nerve injury secondary to burn injury

Case Description: 51 year old male presented as a victim of house fire and suffered 35% total body surface area burn injury to bilateral upper extremities, and back along with extensive inhalation injury and underwent debridement, excision, and grafting and reconstruction of right hand and fingers. Two years later presented with numbness across the palmar aspect of the right hand with weakness. EMG reported right sensorimotor demyelinating median neuropathy at the wrist suggestive of carpal and cubital tunnel syndrome. Patient underwent a right carpal tunnel, guyon's canal, and cubital tunnel release. Followed with progressive occupational therapy modalities, resulting in improved numbness, strength and fine motor skills.

Discussions: Burn patients are at risk of various complications, including infections and impaired blood flow. These complications can further exacerbate nerve damage and demyelination. The hyperesthesia following burn injury may mimic CTS symptoms. Additionally, studies have shown an increased number of CTS cases following thermal burn injury than any other kind of burn, as well as an increased incidence in male burn patients, as was the case in our patient. The etiology of peripheral nerve injury following burns of the hand and wrist includes compression due to swelling and ischemic injury. Nerve conduction studies and electromyography of the upper extremity is diagnostic for CTS. Treatment includes non-invasive measures such as wrist splinting, physical and occupational therapy as well as invasive procedures such as injections and decompression surgery.

Conclusions: Burn patients with demyelinating nerve injuries often require extensive rehabilitation to regain function and minimize long-term disability.Nerve conduction studies and electromyography (EMG) can help assess the extent and severity of nerve damage. Follow up of upper extremity burn victims should include surveillance for compression or demyelinating symptoms as early recognition along with decompression and rehabilitation can lead to functional improvement.