Poster 69: Brachial plexopathy in patient undergoing surgical repair of rotator cuff rupture: a case report

Abstract

Setting: Tertiary care university hospital. Patient: A 45-year-old athletic male. Case Description: The patient had difficulty in overhead abduction of arm and complained of pain, which on radiographic investigation was found to be secondary to partial tear of rotator cuff tendons. The patient underwent a trial of physical therapy for 2 months but did not find any improvement. He decided to undergo surgical intervention. A brachial plexus block was planned for the anesthesia. After several attempts, a successful plexus block was given and the patient underwent repair and was discharged postoperatively using a sling. He started developing numbness and tingling over the entire arm, including hands and fingers, within days after surgery. After 2 weeks, he was also found to have limited range of motion (ROM) at the shoulder joint. 4 weeks after his clinical symptoms appeared during postoperative rehabilitation, physiatrists conducted on electromyographic study and magnetic resonance imaging (MRI). The electromyographic results showed upper trunk plexopathy and the MRI showed inflammation the around the upper trunk. Assessment/Results: The patient was treated aggressively with pain medications, and physical therapy (PT) exercises, but after 9 months of therapy he still had weakness in all the rotator cuff muscles and limited ROM. Discussion: Physiatrists often assume care for patients after orthopedic procedures and they should be aware of the complications that surgical interventions can cause. Although brachial plexopathy was not a complication of the surgery per se, it probably occurred secondary to the difficult brachial plexus block. A high degree of suspicion in this case helped the physiatrists to do the necessary tests and to find out the cause. When appropriately diagnosed PT prescriptions can be tailored to address this problem with appropriate expectations of clinical outcome. Conclusion: Brachial plexopathy may develop as a complication due to anesthesia in the patients undergoing rotator cuff repair.