Spontaneous brachial plexus hemorrhage-case report.
BACKGROUND
Shoulder hemorrhage resulting in brachial plexus neuropathy is a rare occurrence most often seen in cases of traumatic injury or anticoagulation therapy. We report a unique case of spontaneous brachial plexus hemorrhage.


METHODS
This is the first report of a spontaneous shoulder hemorrhage in which a 48-year-old jackhammer operator presented to the emergency department with a sudden onset of right shoulder pain and upper extremity pain and numbness. Imaging studies revealed a hematoma in the right axilla and chest wall. Without evidence of active bleeding or worsening neurologic deficit, this patient was treated conservatively with pain control and observation and eventually experienced a full recovery. Had there been persistent neurologic deficit, however, surgical evacuation would have been indicated.


CONCLUSIONS
Cases of nerve compression caused by a hematoma should be analyzed on the basis of the severity of the neurologic deficit and not on the underlying cause of bleeding. Conservative treatment may be indicated in cases of mild or improving neurologic deficit, but regardless of its etiology, a hematoma that results in severe or worsening neurologic symptoms must be surgically evacuated to prevent permanent nerve damage.
Heller
A C
AC
School of Medicine, Oregon Health Sciences University, Portland, 97201-3098, USA.
Kuether
T
T
Barnwell
S L
SL
Nesbit
G
G
Wayson
K A
KA
D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000792:Angiography / Q000379:methods; D001917:Brachial Plexus / Q000000981:diagnostic imaging* / Q000473:pathology*; D020516:Brachial Plexus Neuropathies / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D003937:Diagnosis, Differential; D006406:Hematoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D012782:Shoulder / Q000098:blood supply
D018712:Analgesics, Non-Narcotic; D007052:Ibuprofen