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Iatrogenic Brachial Plexopathy With Lateral Cord Transection
 

Author: Milan Oxspring, MD
Affiliation: Mayo Clinic, Department of Physical Medicine and Rehabilitation
Co Author(s): James B. Meiling, DO
Senior Editor: Wesley Troyer, DO

Clinical Vignette: A 61-year-old right-handed female developed immediate postoperative right upper extremity weakness, numbness, and severe pain following a right reverse shoulder arthroplasty which is complicated by axillary vein thrombosis and postoperative hematoma. Exam is notable for diffuse upper extremity weakness, though most prominent with elbow flexion, wrist flexion, and finger flexion. There are absent deep tendon reflexes of the biceps brachii and brachioradialis.

Type of Probe Used: 4-18 MHz linear-array ultrasound transducer



Labeled short axis view of the lateral cord of the right brachial plexus in the infraclavicular window. At this site there is focal enlargement of the lateral cord (dashed line, cross-sectional area 26.85 mm2), just distal to the cord transection (not visualized in this image). In this view, the lateral cord lies deep to both the pectoralis major and minor muscles, lateral to the axillary artery (asterisk). The posterior cord is seen deep to the axillary artery, marked by arrowheads.


Unlabeled short axis view of the lateral cord of the right brachial plexus in the infraclavicular view.


Labeled long axis view of the lateral cord of the right brachial plexus lying deep to the pectoralis major and minor muscles in the infraclavicular view. The lateral cord (dashed line) is seen to approach distal to proximal but abruptly ends (arrow) as the cord becomes focally hypoechoic and disorganized, indicating complete lateral cord transection (neural discontinuity or neurotmesis).


Unlabeled long axis view of the lateral cord of the right brachial plexus in the infraclavicular view.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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