Complicated Brachial Plexus Lesion - I need some advice.

Complicated Brachial Plexus Lesion - I need some advice.

North, Rebecca

7/2/2002

I have a 33yo male client with Charcot Marie Tooth disease and peripheral
neuropathy.

He had a fall ~ 3 years ago resulting in a Right Upper Trunk Brachial
Plexopathy.
Neurology report, supplied by client, as follows:-

Report
Only very occasional spontaneous activity was noted, most evident in right
brachioradialis and occasionally in deltoid and biceps. Some large
long-duration polyphasic motor units were seen particularly in right deltoid
and infraspinatus. Recruitment was markedly reduced in deltoid, biceps and
no units identified in brachioradialis. Mild reduction in recruitment was
seen in ECR and right rhomboids. Triceps, serratus anterior, pronator teres
and cervical paraspinal examination appeared to be normal.

Comment
This was a difficult study since it is reportedly more than 2 years since
the injury and only minor spontaneous activity was evident with accompanying
features of partial re-innervation. Severe underlying hereditary
sensori-motor neuropathy compromises additional nerve conduction studies.

Assuming a monophasic process, the most likely location of pathology is an
incomplete right upper trunk brachial plexopathy. There is C5/6 involvement
of muscles innervated by suprascapular nerve(infraspinatus), axillary
nerve(deltoid), musculo-cutaneous nerve(biceps) and radial
nerve(brachioradialis).

There is relative or complete sparing of more proximal C4/5/6 innervated
muscles eg. Rhomboid(dorsal scapular nerve), serratus anterior(long thoracic
nerve) and mid-lower cervical paraspinal muscles seemed to be normal.
Triceps (predominantly C7-radial nerve) was normal and extensor carpi
radialis(radial nerve) only slightly abnormal.

Clinical Notes
There is incomplete re-innervation of several muscles with poor recruitment
after 2 years. Cannot see rationale for surgical intervention at this time.

Client reports
*Shoulder dislocation, with overhanging threat of surgical fusion.
*Some mid range elbow control (assisted by postural changes)
*Inability to carry objects.
*Hand function effected by CMT more than by brachial plexus lesion.

Clients aims
*Shoulder stabilisation.
*Optimise elbow control to enable some ability to lift, position and/or
carry small items.

Complications
*Poor Balance
*Walking stick usage limits ability to isolate and recruit left shoulder
protraction/retraction for any harnessing options.
*Hereditary sensori-motor neuropathy is degenerative.

My Thoughts
*Shoulder stabilisation rigid or flexible orthosis
*Ratchet type elbow joint

**Please email any thoughts or experiences which may help this gentleman. He
and I would both appreciate the help**

<Email Address Redacted>

Deanne Galvin
Bachelor of Prosthetics and Orthotics
(Australia)