Disclosures: Madeline A. Kinney, DO: Nothing to disclose

Case Description: A previously healthy patient with direct blast exposure resulting in multiple orthopedic injuries presented to the inpatient polytrauma center for comprehensive rehabilitation. During admission, the patient complained of right elbow flexion weakness with intact supination and sensation throughout. Right upper extremity injuries included: diffuse fragmentation wounds, grade II open midshaft ulnar fracture and grade I open metacarpophalangeal and proximal interphalangeal fractures of the third digit. In addition, patient history revealed tourniquet application to all four extremities following the blast exposure. He was ultimately referred for electrodiagnostic testing with suspicion for a right musculocutaneous nerve lesion.

Setting: Inpatient Polytrauma Rehabilitation Center

Patient: A 22-year-old active duty army male with multiple orthopedic trauma.

Assessment/Results: Electrodiagnostic studies showed evidence suggestive of an incomplete, axonal loss lesion to the right musculocutaneous nerve at or proximal to the innervation of the biceps. Details to be discussed.

Discussion: Isolated musculocutaneous nerve injury is extremely rare and typically associated with damage to additional surrounding nerves of the brachial plexus. Few reported cases were associated with strenuous physical activity, weight lifting, surgery and trauma. We report a case of incomplete, axonal loss lesion to the right musculocutaneous nerve with electromyography findings suggestive of the lesion at the proximal right upper extremity. We suspect tourniquet injury is the most probable cause of neuropathy after ruling out other sustained orthopedic injuries.

Conclusion: This was a rare case of an isolated, incomplete right musculocutaneous nerve lesion from suspected crush injury due to tourniquet application causing elbow flexion weakness with preserved upper extremity supination and sensation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/incomplete-right-musculocutaneous-nerve-palsy-from-suspected-crush-injury-due-to-tourniquet-application-a-case-report/