Brachial plexus injury

Case history #1

A 24-year-old man presents 6 weeks after a motorcycle accident having sustained polytrauma to the right upper extremity. Three ipsilateral rib fractures are present and humeral and forearm fractures are also noted. The patient has 0/5 Medical Research Council (MRC) motor scale strength in the entire right upper extremity. There is sensory loss in the C4 through to T1 dermatomes. There is retention of sensibility in the posterior arm.

Case history #2

A 32-year-old man presents to the emergency department with a history of having fallen from a 10-foot platform at work onto the left shoulder, forcing the head and neck away from the injured shoulder and stretching the neck on the left side. He has no shoulder or biceps function but retains strong triceps function as well as intact functional strength below the elbow. He has patchy loss of sensibility over the shoulder and forearm as well as the thumb and index finger.

Other presentations

Loss of motor and/or sensory function in anatomical areas of the upper extremity corresponding to the 5 roots comprising the brachial plexus may arise from a variety of other causes. Parsonage-Turner syndrome is an idiopathic, inflammatory disorder of the brachial plexus arising after antecedent flu-like syndromes or trauma, such as childbirth or surgery on another part of the body. Severe pain with atrophy of the shoulder muscles and gradual return of function is noted.

Gradual loss of motor or sensory function with limited pain may be found associated with tumours of the brachial plexus. Neurofibromas, schwannomas, and metastatic tumours are the most common.