Disclosures: William P. Christensen, MD: No financial relationships or conflicts of interest

Case Description: Patient was involved in a motor vehicle accident with resultant bilateral 1-7 rib fractures, sternal fracture, extensive subcutaneous emphysema throughout the chest/neck, right hemopneumothorax, left pneumothorax, left femur fracture, and left tibia plateau fracture. Patient discharged to inpatient rehabilitation on hospital day 28, when he began to notice right greater than left grip strength weakness as well as diminished sensation/paresthesias over the medial aspects of his forearms into the 4th and 5th digit. He was noted to have atrophy of the bilateral interossei muscles. EMG/NCS performed approximately three months after the initial injury revealed an incomplete bilateral lower trunk/medial cord plexopathy.

Setting: Inpatient Rehabilitation Hospital

Patient: A 59 year-old gentleman with no significant past medical history. Assessment/

Results: After acute hospitalization, patient underwent 21 days of intensive inpatient rehabilitation, followed by continued outpatient Occupational Therapy. Patient’s grip and pinch strength progressively improved over time. He reports continued paresthesias and sensory deficits throughout the medial arms into the 4th and 5th digit.

Discussion: Traumatic bilateral brachial plexopathies are exceedingly rare and there are a paucity of examples within the literature. Fractures of the upper ribs, notably fracture of ribs 1-3 are associated with high-energy trauma and may demonstrate concomitant injury to the brachial plexus due to the proximity of the upper ribs to the plexus. First rib fractures are also associated with subclavian/aortic vessel injuries, cardiac/pericardial injuries, lung injuries, traumatic brain injuries, cervical and thoracic spine injuries, and pelvic ring fractures. As such, brachial plexus injuries may not be considered on primary and secondary trauma survey due the life-threatening nature of their injuries .

Conclusion: Close and prudent follow-up is necessary to monitor for injuries to neurovascular structures in the setting of high-energy traumatic injuries with upper rib fractures. Brachial plexus lesions can often lead to significant physical disability and psychosocial distress.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unusual-case-of-traumatic-bilateral-brachial-plexopathy-a-case-report/