Disclosures: Tunc C. Kiymaz, MD: No financial relationships or conflicts of interest

Case Diagnosis: Bilateral brachial plexopathy

Case Description: A 58-year-old male was diagnosed with COVID-19 in April 2020, requiring treatment including plasmapheresis, prone positioning, intermittent paralysis, and eventual tracheostomy placement after 3 weeks of endotracheal intubation. He developed necrotizing fasciitis of the left forearm and hand, undergoing multiple debridement procedures. He complained of patchy weakness and numbness of the upper limbs after weaning of sedation. He was in acute hospitalization for 6 weeks before discharge to a skilled nursing facility for 2 months and eventual discharge home.

Setting: Outpatient electrodiagnostic centerAssessment/

Results: Electrodiagnostic studies were done 6 months and 9 months following the patient’s initial admission for COVID-19 due to persistent weakness and sensory loss of bilateral upper limbs. Initial study was limited in the left upper limb due to the presence of wounds. Results of the first study indicated an acute on chronic right brachial plexopathy affecting the upper and middle trunks with sparing of the lower trunk, as well as a possible left lower plexus lesion with evidence of axon loss. The second detailed left upper limb study revealed significant axon loss with neuropathies of the radial, ulnar, and median nerves. Based on these results and a superimposed critical illness myopathy and neuropathy, brachial plexopathy could not be ruled out but was suspected due to similar findings on the right sided study.

Discussion: There are reports of unilateral brachial plexopathies resulting from prone positioning, but not of bilateral plexopathies. The rates of prone positioning in the ICU are dramatically higher as a result of the COVID-19 pandemic. The patient in this case is unique because he developed bilateral brachial plexopathy during ICU stay.

Conclusion: Further research regarding how to safely prone patients and prevent brachial plexopathies is needed. This is important as prone positioning is becoming standard of care in COVID-19 patients.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-brachial-plexopathy-due-to-prone-positioning-during-covid-19-treatment-a-case-report/