BRACHIAL PLEXUS INJURY SECONDARY TO SHOULDER TRAUMA: EARLY DIAGNOSTIC APPROACH AND MULTIDISCIPLINARY MANAGEMENT. CASE REPORT AND NARRATIVE REVIEW

Abstract

DOI: https://doi.org/10.46296/yc.v10i18.0871

Abstract

Background: Traumatic brachial plexus injuries are diagnostically and therapeutically challenging because they may severely affect shoulder, elbow and hand function. In shoulder trauma, particularly glenohumeral dislocation, fracture-dislocation or high-energy traction mechanisms, neurological deficits may be overlooked when attention is focused on joint reduction or fracture management. Objective: To present a clinical case of brachial plexus injury secondary to shoulder trauma, emphasizing early neurological examination, combined imaging and electrodiagnostic assessment, timely referral to peripheral nerve surgery and multidisciplinary rehabilitation. Case presentation: A previously healthy 29-year-old man sustained a traumatic anterior dislocation of the left shoulder after a motorcycle accident. After closed reduction, he had persistent neuropathic pain, sensory loss in the axillary nerve territory and severe weakness of shoulder abduction, external rotation and elbow flexion. Brachial plexus MRI showed upper trunk edema without root avulsion. Electromyography performed at four weeks revealed a severe postganglionic axonal C5-C6-predominant lesion involving the axillary, suprascapular and musculocutaneous nerves. Due to insufficient early recovery, he underwent nerve reconstruction with spinal accessory-to-suprascapular nerve transfer and triceps motor branch-to-axillary nerve transfer, followed by specialized rehabilitation. Conclusions: Shoulder trauma with persistent neurological deficit should be considered a brachial plexus injury until proven otherwise. Early motor, sensory and vascular documentation, MRI/neurography, serial electrodiagnostic studies and timely multidisciplinary decision-making may prevent delays that compromise reinnervation and functional outcome.

Keywords: brachial plexus; shoulder trauma; shoulder dislocation; peripheral nerve injury; electrodiagnosis; magnetic resonance imaging; nerve transfer; rehabilitation.