Brachial Plexus Injury-Adult-Case: Brachial Plexus Trauma

Case: Brachial Plexus Trauma

Pdf Summary

A 20-year-old male presented with persistent left-sided shoulder and elbow weakness following a motorcycle accident three months ago. He also complained of diffuse dull pain in his hand, elbow, and shoulder. He had spent two weeks in the ICU, where he was intubated and discharged to an inpatient rehabilitation center after six weeks. The patient had a small subdural hemorrhage, left rib fractures, first metacarpal fracture, and facial fractures. Physical examination revealed weakness in various muscle groups, with limited range of motion in the left shoulder and elbow. Electrodiagnostic studies showed intact sensory nerve action potential in certain areas but no compound muscle action potential in the affected muscles. Radiographic studies revealed subluxation of the humeral head and non-displaced rib fractures. A CT myelogram showed a pseudomeningocele involving the roots at C5-C6 and C6-C7. The diagnosis was an upper trunk injury involving C5 and C6, likely preganglionic avulsion involving both roots. The treatment plan consisted of non-operative treatment, including physical and occupational therapy to improve range of motion and strengthen functioning muscles. Surgical management was also considered, with nerve transfers to restore elbow flexion, shoulder abduction/forward flexion, and shoulder external rotation. Post-operative care involved a shoulder sling and physical therapy starting at three weeks after surgery. The patient was considered a potential candidate for nerve reconstruction due to the timing of the injury. Imaging, such as chest X-ray and CT myelogram, helped with diagnosis and evaluation of the pattern of injury. Electrodiagnostic studies confirmed the axonal loss pattern. Treatment options included single or double fasicular transfers depending on the availability of intact donor fascicles. Rehabilitation focused on promoting range of motion and muscle innervation.

Keywords

shoulder weakness

elbow weakness

motorcycle accident

rib fractures

facial fractures

electrodiagnostic studies

CT myelogram

upper trunk injury

nerve transfers

rehabilitation