Brachial plexus injury: Following birthday bumps
The present case has been reported in the Journal of Orthopaedics and Allied Sciences.

A 14-year-old male patient brought by parents in outpatient department with complaints of weakness along the left shoulder joint, prominent scapula and shooting pain, numbness along the shoulder and the arm along the C5, C6, and C7 distribution, next day after the onset of symptoms. The mechanism of injury was unknown to parents; initially, the patient hid the mechanism of injury. After assurance, the patient gave a history of beatings as birthday bumps around the back and shoulder joints.

Clinical examination revealed bruises along the shoulder, painful and restricted neck movements and deficit along the C5, C6, and C7 roots. There was winging of scapula, biceps weakness (power: 3/5), axillary nerve deficit (power: 0/5). Tinel's sign was positive initially, no progression of stimulation point over the time.

X-ray showed no bony abnormality, minimal soft-tissue edema. Plane MRI revealed edema along the brachial plexus with no anatomical discontinuity. Medically managed with short-term steroids (Dexamethasone 8 mg thrice daily for 7 days), nonsteroidal anti-inflammatory drugs (Naproxen 250 mg twice daily for 3 weeks), Pregabalin (75 mg twice daily for 2 weeks followed by once daily for the next 2 weeks), and Methylcobalamin (1500 mcg per day for 4 weeks). Immobilization with arm sling (ideally being the aeroplane splint for relaxation of the injured structures and prevention of contracture) done for 6 weeks, as it was easily available and the patient can attend school easily.

Pain and swelling subsided after 3 days. The sensory deficits recovered after 3 weeks and motor deficit returned after 8 weeks. He was kept on physiotherapy with biceps strengthening exercises, shoulder range of movement, and abductor strengthening exercises for 6 weeks.
The patient recovered completely without any sequelae following 3 months after injury.

Key takeaway:-
Teenagers especially college and hostel students may hide the mechanism of injury, and it may distract the physician from arriving at proper diagnosis. To avoid similar injuries in future, it needs counseling and proper adolescence care.

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