Disclosures: Christina M. Giacomazzi, DO: Nothing to disclose

Case Description: The patient was on a training bicycle going 40 MPH and fell over the handlebars. He sustained a severe traumatic brain injury (TBI) and multiple facial fractures. He was transferred to acute rehabilitation 16 days after injury. During rehab, he emerged into a Rancho IV and had persistent right shoulder pain. X-ray of the shoulder was negative for fracture. Four weeks after injury, he was out of post traumatic amnesia with continued right shoulder pain with numbness in bilateral forearms which limited functional progress in therapies. On examination, he had atrophy of the right>left deltoid, supraspinatus, and infraspinatus. He had weakness in right shoulder abduction, external rotation and mild weakness in left wrist extensors and finger flexors with sensory loss over the left dorsal thumb. MRI of the bilateral brachial plexus 5 weeks after injury showed thickened C4-C7 nerve roots with hyperintense signal and edematous changes of the right supraspinatus, infraspinatus, and subscapularis. EMG was performed 6 weeks after injury showing a bilateral, subacute, upper trunk brachial plexopathy (right more than left) with ongoing denervation in C5-C6 distributions.

Setting: Acute Rehabilitation Hospital

Patient: A 51-year-old male with bilateral upper extremity weakness and sensation changes after traumatic brain injury.

Assessment/Results: At 6 months post injury, he had improved strength in right shoulder abduction and left wrist extension with improvement in bilateral upper extremity ADL function

Discussion: This is the first reported case, to our knowledge, of bilateral brachial plexopathy in a traumatic brain injury patient after a bicycle accident

Conclusion: This case highlights a rare but important diagnosis of bilateral brachial plexus injury after traumatic accident that was initially not discovered likely secondary to TBI. The differential of bilateral upper extremity weakness and sensory changes after TBI also includes bilateral brachial plexus injuries.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/traumatic-bilateral-brachial-plexopathy-after-bicycle-accident-a-case-report/