Brachial plexopathy following thoracoscapular fusion in facioscapulohumeral muscular dystrophy

Abstract

A hallmark feature of facioscapulohumeral muscular dystrophy (FSH) is prominent weakness of shoulder girdle musculature, instability of the scapular platform, and impairment of shoulder flexion and abduction.1 Subsequently, many patients with FSH lose the ability to raise their arms for overhead tasks. Thoracoscapular fusion (TSF), whereby the scapula is attached via flexible wires and either metal plates or bone blocks to the posterior rib cage, corrects these functional limitations in selected patients.2 Brachial plexus injuries are not widely reported as complications of TSF. We present two individuals with FSH who developed upper trunk plexopathies following TSF. ### Case 1. A 47-year-old man with FSH confirmed by 4q35 deletion analysis underwent right TSF. Right shoulder function improved markedly, restoring the ability to elevate his right arm above his head. However, elbow flexion strength fell from Medical Research Council (MRC) grade 4 to 0 with loss of the biceps tendon reflex and sensory loss in the C6 dermatome. Electrodiagnostic studies localized the injury to the upper trunk with fibrillation potentials in muscles sharing the …