Physician LVHN Allentown, Pennsylvania, United States
Case Diagnosis: Upper Trunk Brachial Plexopathy
Case Description: We present a case of a 63-year-old male who experienced a work injury while carrying a heavy window. He subsequently developed shoulder pain and weakness, numbness in his shoulder and forearm, and scapular winging. Initial EMG indicated a possible C5-C6 radiculopathy. Follow-up EMG revealed potential C5 root avulsion. However, MRI of the brachial plexus did not show any definitive signs of root avulsion. The patient followed up with neurosurgery, who did not recommend surgical intervention at the time due to evidence of some nerve regrowth. Subsequent EMG 7 months post-injury showed an upper trunk brachial plexopathy that was thought to be more consistent with Parsonage-Turner Syndrome. Follow-up EMGs have been scheduled in the future to determine the most appropriate diagnosis and if surgery will ultimately be warranted.
Discussions: This paper illustrates a unique case of an upper trunk brachial plexopathy caused by a tractional injury. The patient’s pain and weakness immediately following injury were characteristic of a traumatic injury. Therefore, rotator cuff tear, cervical radiculopathy, and root avulsion are all pathologies that were initially considered during the patient’s workup. Follow-up imaging and EMGs initially supported root avulsion, then later supported Parsonage Turner Syndrome. However, this would be an atypical presentation of Parsonage-Turner Syndrome since pain is the first symptom 90% of the time and weakness typically follows several days to weeks after pain develops. Follow-up EMGs may guide us in establishing a more definitive diagnosis. One limitation of this case report is that all the EMGs were interpreted by different physicians, thus the interpretations may vary somewhat.
Conclusions: This case demonstrates the importance of keeping a broad differential diagnosis when evaluating a patient with suspected brachial plexus injury. Additionally, this case emphasizes the importance of a comprehensive diagnostic approach, especially utilizing serial EMGs, in these patients.
