Disclosures: Michael D. Guthrie, MD: No financial relationships or conflicts of interest

Case Diagnosis: We present two cases of brachial plexopathy as a result of proning in the treatment of COVID-19.

Case Description: Patient 1 is a 60-year-old male who presented with COVID-19 associated respiratory failure requiring mechanical ventilation. He was in prone positioning approximately 16 hours per day for 10 total days. Patient 2 is a 60-year-old male with no significant past medical history who presented with progressive respiratory failure secondary to COVID-19 requiring mechanical ventilation. He underwent proning for at least 16 hours a day for 13 days.

Setting: Inpatient rehabilitationAssessment/

Results: Patient 1 completed electrodiagnostic testing 87 days after proning, with findings representing a left brachial plexopathy with motor and sensory loss reflecting affected upper, middle, and lower trunks and a right brachial plexopathy with significant involvement of the middle and lower trunks. Patient 2 completed electrodiagnostic testing 53 days after proning. There was diffuse active denervation in the bilateral upper limbs, with severe involvement of the left-hand intrinsic and extensor indicis proprius muscles, most likely consistent with bilateral brachial plexus injuries at the level of the trunk.

Discussion: These cases characterize the potential complication of brachial plexopathy from proning in the treatment of COVID-19. Although the superficial location of the upper trunk is at risk for compression, we present that multiple trunks are susceptible to injury. Our findings also support coincidental critical illness myopathy and neuropathy, suggesting multiple etiologies of weakness should be considered in this patient population.

Conclusion: Further investigation of positioning techniques to minimize nerve injury is warranted. Interventions that may improve functional outcomes including physical and occupational therapies with modalities should also be evaluated. In conclusion, this case series extends our understanding of a known complication of proning in the treatment of ARDS, informing rehabilitation evaluation and management of patients recovering from COVID-19.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/brachial-plexopathy-from-prone-positioning-in-the-treatment-of-covid-19-a-case-series/