Summary of - Bilateral Post‐traumatic Brachial Plexus Injury in an Adult: A Note on the Probable Mechanism of Injury

Document Type

Article

Abstract

Background: Bilateral brachial plexus injuries are rare, particularly post-traumatic cases resulting from motor vehicle accidents. This report discusses a unique case involving a 35-year-old male with a bilateral injury characterized by ipsilateral C5,6 avulsion on the right and contralateral C5,6 traction injury on the left after a three-wheeler collision.

Case Presentation: The patient presented with bilateral upper limb weakness four months post-accident, initially treated non-operatively without improvement. Clinical examination revealed an absence of active shoulder abduction and elbow flexion bilaterally. Electrophysiological studies indicated axonal neuropathy, with the right side being more severely affected. Intervention: Exploration on the right side showed extensive C5 and C6 root fibrosis with no healthy proximal roots near the foraminal exit. The spinal accessory nerve transferred to the suprascapular nerve. At the arm, an ulnar nerve fascicle and median nerve fascicles were transferred to the biceps and brachialis branch of the musculocutaneous nerve for elbow flexion. In addition, the long head of the triceps branch was transferred to the axillary nerve. The left brachial plexus supraclavicular exploration showed epineural fibrosis with continuity of roots and trunks. Neurolysis was performed as roots responded to electric stimulation.

Results: At the 12-month follow-up, the patient demonstrated complete recovery in the left upper limb and partial recovery with MRC grade 4 in the right biceps and grade 3 in shoulder muscles. The patient was able to return to farming activities. Discussion: This case illustrates the mechanisms of bilateral brachial plexus injuries, highlighting the importance of understanding injury mechanisms for prognosis and treatment strategies. Prompt surgical intervention proved beneficial, with differences noted in recovery based on the type of injury on either side.

Conclusion: The mechanism of injury in a bilateral plexus injury is intriguing. In a scenario such as our patient, the avulsion side will suffer more insult than the recoil side. However, prompt and early intervention can provide almost equal functional outcomes on both sides with appropriate strategies like nerve transfers and neurolysis based on intra operative findings.

Publication Date

2023

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