| 제목 |
Ipsilateral Brachial Plexus Injury after Surgery for Hip Dysplasia : A Case Report |
| 소속 |
Pusan National University School of Medicine, Pusan National University Hospital, Department of Rehabilitation Medicine1, Biomedical Research Institute, Pusan National University Hospital, Department of Rehabilitation Medicine2 |
| 저자 |
Young Mo Kim1*, Tae Woong Yang1, Dong Ho Yoo1, Sang Hun Han1, Ji Won Hong2, Jae Hyeok Chang2, Byeong Ju Lee2† |
Introduction
The brachial plexus is located in easily exposed area to external shocks and can be damaged by various injuries such as traction or compression. For this reason, brachial plexus injury (BPI) due to malpositioning is well-known complication during general anesthesia.
We report a rare BPI case on the contralateral arm which was not compressed during side lying position.
Case Report
A 20-year-old male patient visited department of orthopedic surgery, complaining of left hip pain while walking. He was born at 39 weeks gestation by normal spontaneous vaginal delivery. His height was 171 cm and weight was 65 kg (body mass index [BMI], 22.2). He was diagnosed as left hip dysplasia and underwent periacetabular and femur valgus osteotomy and bone graft. At the beginning of the operation, he was in the supine position. The operation was mainly performed in the right decubitus position most of the time. His head was in the neutral position and his left arm was on the arm board in abduction of 70 °. There were neither prolonged hypotensive episodes nor other intraoperative complications. The procedure lasted for 8 hours. When he woke up from anesthesia, he noticed weakness and numbness in left arm. A manual muscle test (MMT) grades at left shoulder flexion and abduction were poor and external rotation was fair; elbow flexion and extension were trace; wrist flexion and extension were poor; finger flexion was poor and extension was zero.
Nerve conduction study and electromyogram were done 15 days after the surgery and left BPI, especially lateral and posterior cord lesion was confirmed (Table 1, 2). In magnetic resonance imaging showed diffuse and smooth hypertrophy of the left 6th to 8th cervical nerve roots, at mainly division and cord level. There was no space occupying lesion that could compress brachial plexus (Fig. 1). He was transferred to Department of Rehabilitation medicine and underwent physical and occupational therapy with electrical stimulation. After 6 weeks, the MMT grade of elbow flexion and extension recovered from trace to poor and wrist flexion and extension, finger flexion recovered to fair from poor and finger extension to poor from zero.
Discussion
Ipsilateral BPI usually occurs in lateral decubitus position during general anesthesia by compression on the chest and the humeral head. Through this case, BPI occurred in the contralateral side that was not compressed in the lateral position. We assume that it occurred by excessive traction on the upper extremity during position change or prolonged malposition on the arm board. In conclusion, attention to the adequate positioning under general anesthesia could prevent nerve injuries or the potential disabilities.
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Findings of nerve conduction study 14 days after the surgery
Findings of needle electromyogram 14 days after onset
T2-weighted magnetic resonance imaging demonstrated high signal intensity at the left brachial plexus (arrow)
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