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Auslösung von Phantomschmerzen und -sensationen durch muskuläre Stumpftriggerpunkte nach Beinamputationen

Referred pain from amputation stump trigger points into the phantom limb

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Zusammenfassung

Fragestellung

Lokalisationen muskulärer Triggerpunkte (TP) in Amputationsstümpfen und deren Auswirkungen auf Phantomwahrnehmungen sollten erstmals untersucht werden.

Methode

Bei 30 Beinamputierten (12 OS,18 US) wurden die 5 auffälligsten Stumpf-TP aufgesucht und die Palpation standardisiert dokumentiert. Phantomschmerzen (PSz), Phantomsensationen (PSs), Stumpfschmerzen (SS) und Phantombewegungen wurden erfragt, Stumpfschlagen und Faszikulationen beobachtet.

Ergebnisse

Fast keiner der TP war vorher bekannt. Dorsaler PSz nach ventraler Palpation trat ebenso auf wie Zehen-PSz nach Pulpation hüftnaher TP. 20/30 Patienten berichteten PSs, 8 über PSz. 60/150 TP erzeugten PSs, 17 PSz. Phantomempfindungen entfielen zu 62,8% auf die Zehen (Großzehe 19,8%, Zehen 2–5 je 9–11%), 17,9% den Mittelfuß und nur ca. 10% den US. Ca. 70% der TP lagen 3–7 cm proximal der Stumpfspitze. Zehenausstrahlung wurde vermehrt vom Stumpfende, der Unterschenkel häufiger proximal ausgelöst.

Schlussfolgerung

Stumpf-TP sind häufig und wenig beachtet, ihre Palpation führt oft zu Phantomwahrnehmungen. TP könnten zur zentralen Sensibilisierung oder Erweiterung spinaler, rezeptiver Felder beitragen und es erscheint denkbar, dass das TP zugeordnete Phänomen des „referred pain“ pathophysiologisch ähnlich entsteht wie Phantomschmerzen.

Abstract

Objectives

The aim of the study was to examine whether/how myofascial stump trigger points (TPs) after lower leg amputations are able to produce stump pain (SP), phantom pain (PP), and sensations (PS) in the phantom limb.

Methods

Palpation of the 5 most striking stump TPs of 30 leg amputees (12 transfemoral, 18 transtibial) was documented in a standardized manner. Patients were asked to localize SP, PP, and PS.

Results

Of 150 TPs, 14 produced involuntary stump movements and 10 stump fasciculations. Dorsal PP after ventral TP palpation occurred as well as PP in the toes from TPs near the hip. Of 30 patients, 20 reported PS and 8 PP; 60 of 150 TPs produced PS and 17 PP. Phantom phenomena were localized in 62.8% in the toes (1st toe 19.8%, toes 2–5 about 10% each), 17.9% midfoot, and the rest were more proximal. TPs were localized more in the lateral/dorsal stump than medial/ventral. About 70% of the TPs were found between 3 and 7 cm from the stump end, those with toe projections more distal than those with tibial projections.

Conclusions

Myofascial TPs in amputation stumps are common and able to produce sensations and pain in the phantom limb. Most reported experiences were localized in the toes, as phantom pain usually is. There seems to be a “stump representation” and it seems possible that “referred TP pain” and “phantom pain” may develop from similar origin.

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Authors and Affiliations

  1. Schmerz- und Palliativzentrum, Wiesbaden

    K.-U. Kern

  2. Abt. für Anästhesiologie/Intensivmedizin/Notfallmedizin und Schmerztherapie, Städt. Klinikum Kemperhof, Koblenz

    C. Martin, S. Scheicher & H. Müller

  3. Schmerz- und Palliativzentrum Wiesbaden, Blücherplatz 2, 65195 , Wiesbaden

    K.-U. Kern

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  1. K.-U. Kern
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  2. C. Martin
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Correspondence to K.-U. Kern.

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Kern, KU., Martin, C., Scheicher, S. et al. Auslösung von Phantomschmerzen und -sensationen durch muskuläre Stumpftriggerpunkte nach Beinamputationen. Schmerz 20, 300–306 (2006). https://doi.org/10.1007/s00482-005-0446-3

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