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Final Program

475 - Traumatic bilateral medial cord plexopathy in a 22 years-old female secondary to gun shot wounds, a case report

Friday, February 28, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • JM

    Jean Paul Moliere Velez, MD

    Resident Physician
    University of Puerto Rico - Medical Sciences Campus
    San Juan, Puerto Rico, United States

    • Corresponding Author(s)

  • JG

    Jan I. Garcia Rivera, MD

    Research Fellow
    University of Puerto Rico School of Medicine, Department of Physical Medicine, Rehabilitation, & Rehab
    Toa Alta, Puerto Rico, United States

    • Co-Author(s)

  • CL

    Carmen Lopez-Acevedo, MD

    Professor and Residency Program Director
    University of Puerto Rico, Department of Physical Medicine, Rehabilitation, & Sports Medicine
    San Juan, Puerto Rico, United States

  • IP

    Ivan Perez Vicente, MD

    Resident Physician
    University of Puerto Rico, Medical Sciences Campus
    San Juan, Puerto Rico, United States

  • KD

    Kevin De Jesus Morales, MD

    Resident Physician
    University of Puerto Rico
    San Juan, Puerto Rico, United States

Case Diagnosis: Traumatic Bilateral medial cord plexopathy

Case Description: Case of a 22-year-old female that came for EDX study months after receiving multiple gunshot wounds at bilateral upper extremities. She presented with allodynia, paresthesia and weakness at bilateral hands. Physical exam was remarkable for bilateral intrinsic muscles of hand weakness, and limited flexion of left 1st and 2nd PIPs, atrophy of abductor pollicis brevis and first dorsal interosseous muscles at left hand. Conduction studies showed reduced amplitude in the left median and motor ulnar nerve, reduced amplitude and conduction velocity in the right ulnar motor nerve; and prolonged distal peak latency in the right medial antebrachial cutaneous sensory and right ulnar sensory nerves. EMG was remarkable for increased spontaneous activity, decreased recruitment and decreased interference pattern in the left abductor pollicis brevis; moderately increased spontaneous activity in the left first interosseous, right abductor pollicis brevis, and pronator teres muscles.

Discussions:

The patient's initial findings suggest nerve injury which was confirmed via EDx supporting the importance of these tests in the characterization of plexopathies by location, chronicity, severity and prognosis. Literature suggests bilateral traumatic brachial plexopathies are uncommon, however they can have severe consequences in ADLs and functionality. In our case, the patient hasn’t been able to return to work nor her academic duties. She was prescribed therapies and instructed to RTC in 3 months for follow up.

Conclusions: This rare case of traumatic bilateral brachial plexopathy highlights the high economic burden violence represents in the healthcare system, as well as the toll it takes in the functionality and quality of life of victims. It also highlights the important role and cost effectiveness of EDX in the identification, localization and assessment of severity and prognosis of peripheral nerve injuries, and of physiatrists in the diagnosis and treatment of these injuries.