Functional recovery after radiation induced brachial plexopathy
Vibhu Banala, B.S., Florida International University Herbert Wertheim College of Medicine, Miami, FL, Richard Morgan, D.O., Larkin Community Hospital, Hialeah, FL and Elizabeth Anne Ouellette, M.D., Miami Orthopedics & Sports Medicine Institute, Miami, FL
Introduction: Brachial plexopathy is a form of peripheral neuropathy with multiple implications on the functionality of the upper extremity. Most commonly associated with avulsion and rupture injuries to the nerves, we present a case of a patient who developed radiation induced brachial plexopathy who underwent release of the brachial plexus sheath and the functional recovery afterwards.
Case Discussion: A 54-year-old, right hand dominant, female with a medical history of metastatic breast cancer presented to our clinic with decreased function in her left arm. The patient reported having 30 sessions of radiation therapy 25 years prior to initial presentation in our clinic. In the 2 years prior to our evaluation, she began to have progressive numbness in her fingers, hand pain, weakness in her entire arm, and stiffness in her elbow and shoulder.
Extensive imaging was completed throughout the 2 years prior to our first evaluation of the patient, including a MRI and PET/CT. Results showed loss of fatty connective tissue and no evidence of abnormal FDG uptake that would indicate malignancy.
During our first evaluation of the patient, the neurological examination revealed atrophy of multiple muscles. Muscle strength of ring and small finger flexors, first dorsal interosseous, abductor digiti minimi and abductor pollicis brevis was graded 0/5. Passive and active range of motion in all planes of her shoulder and elbow were limited. The patient was unable to actively pronate/supinate her forearm as well as flex/extend at the elbow. Pinprick and light touch sensation was decreased along the left ulnar nerve and median nerve distribution. Electrodiagnostic studies revealed left brachial plexopathy/medial cord plexopathy likely because of delayed radiation induced plexopathy.
Conservative therapy was initiated followed by a surgical procedure involving decompression and exploration of the left brachial plexus anterior to the shoulder, specifically the radial nerve, median nerve, ulnar nerve, and musculocutaneous nerve was performed by our surgical team. The patient reported immediate recovery of some hand function and sensation after the surgery, which is supported by camera recordings provided by the patient. The patient took the initiative to track the status of her hand function through camera recordings, starting several months prior to her surgery.
Conclusions: The above case represents a rare cause of brachial plexopathy with functional recovery following brachial plexus decompression. The patient's progress shows that this surgery can be a viable treatment for this severe condition.
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