#RareCase Brachial Plexus Palsy Due To A Sneeze
A 55-year-old woman presented to a hospital emergency department with an acute anterior right shoulder dislocation with ipsilateral upper extremity paresthesias and weakness following a violent sneeze. The patient’s past medical history included steroid-dependent asthma, type 2 diabetes, and class 1 obesity.

Her surgical history was significant for an uncomplicated right shoulder arthroscopy and arthroscopic capsular release for adhesive capsulitis of the shoulder 10 years previously.

The shoulder dislocation was then uneventfully reduced within 90 min of dislocation with radiographic confirmation. At 1-week follow-up with her orthopedic physician, the exam demonstrated persistent loss of motor and sensory function. Electromyography and nerve conduction studies (EMG/NCS) were obtained 2 weeks later and confirmed a severe multi-trunk brachial plexopathy characterized by both conduction block and motor axon loss.

Over the next 6 weeks, the patient demonstrated dramatic motor and sensory improvement while participating in a program of physical and occupational therapy. One year after the original injury, her exam revealed only mild motor and sensory impairment in the affected hand.
Points Worth Discussion:-
1. Complete brachial plexus palsy should be considered when a patient presents with profound weakness and sensory loss isolated to the affected limb.
2. On physical exam, they may be unable to squeeze their hand (median/ulnar nerve), flex (median nerve) or extend (radial nerve) their wrist, flex their elbow (musculocutaneous nerve), or abduct their arm (axillary nerve).
3. They will also demonstrate some level of asymmetric sensory impairment.

Source: https://intjem.biomedcentral.com/articles/10.1186/s12245-019-0245-8
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Dr. M●●●●●●●i G●●●l K●●●●●k
Dr. M●●●●●●●i G●●●l K●●●●●k Obstetrics and Gynaecology
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Oct 5, 2019Like