title: Brachial plexus injury due to compression: an alternate mechanism of injury: case report and review of the literature.
abstract: We present a case of a brachial plexus injury due to compression of the nerves from a traumatic hematoma, with no associated bone or vascular injury. The paralysis in this case was not evident for 48 hours after the initial injury, implying that the brachial plexus was not damaged directly. Electromyograms documenting brachial plexopathy were obtained. The mechanism of injury in this case is different from the usual mechanisms of injury in brachial plexus trauma. The majority of brachial plexus injuries are associated with multisystem trauma. The mechanism of injury to the brachial plexus is either from extreme traction on the nerves or direct impact. Downward traction generally results in lesions in the upper cervical nerve roots, whereas upward traction results in lesions of the lower cervical nerve roots, C8 and T1. The usual symptoms of brachial plexus injuries include paralysis of the shoulder, arm, and/or hand with parasthesias and altered sensation. Temperature and color of the limb may be altered because of damage to the autonomic nervous system. The treatment of brachial plexus injuries varies depending on the mechanism and the time the injury is discovered in relation to the inciting trauma. Current treatment includes assessing function with physical examination, preoperative electromyogram, and then repair of viable nerve roots and associated vascular injuries.
authors.affiliation: Department of Surgery, Lankenau Hospital, Wynnewood, Pennsylvania 19096, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Desai
authors.forename: A
authors.initials: A
authors.lastname: Uribe
authors.forename: T
authors.initials: T
authors.lastname: Lachman
mesh_terms: D001365:Axilla / Q000000981:diagnostic imaging; D001917:Brachial Plexus / Q000293:injuries*; D005260:Female; D006406:Hematoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D009408:Nerve Compression Syndromes / Q000150:complications / Q000209:etiology*; D014057:Tomography, X-Ray Computed