Harrison Jordan, DO
Resident
East Carolina University Health
Greenville, North Carolina, United States
David Salchert, MD
Resident Physician
East Carolina University Health
Greenville, North Carolina, United States
Robert T. Lombard, MD
Assistant Clinical Professor
ECU Health Medical Center
Greenville, North Carolina, United States
39-year-old male admitted following a motorcycle collision with intracranial hemorrhage, diffuse axonal brain injury, and clavicular fractures. His hospital course was complicated by acute left arm weakness leading to a stroke workup including MRI brain, MRV, head CT, and CTA head/neck were unremarkable for etiology. On consultation, concern for brachial plexopathy was raised due to maintained hyporeflexia, numbness, and weakness in the patient’s left upper extremity. MRI of the brachial plexus revealed edema along the roots, trunks, and cords of the brachial plexus that suggests underlying nerve injury versus perineural soft tissue trauma. The patient was started on steroid treatment. Limited electrodiagnostic studies (EDX) were completed during his rehab course which were significant for axonal injury to the left median and ulnar nerves with no evidence of demyelinating injury on ulnar and median nerve f-wave studies.
Discussions:
Parsonage-Turner Syndrome (PTS) brachial plexopathy is an uncommon condition that presents with abrupt onset shoulder pain followed by sensory and motor deficits from unclear etiology. Risk factors for the development of PTS include viral illness, vascular disorders, surgical procedures, and physical trauma. PTS is believed to be an axonal process leading to widespread denervation in the upper extremity. The physiatry consult team advocated further workup for a potential left upper extremity brachial plexus injury. PTS remained high on the differential for the patient due to axonal injury found on EDX and MRI, suggesting edema around the brachial plexus roots, trunks, and cords, leading to treatment via steroids. The workup was completed in the inpatient rehab setting via EDX studies, allowing optimal management for the confirmed brachial plexopathy.
Conclusions:
Clavicular trauma alongside acute upper extremity weakness and numbness should illicit consideration of differentials for brachial plexopathy, including PTS, so that the patient may receive prompt treatment and diagnostic evaluation including EDX.
