Go YI, Kim DS, Kim GW, Won YH, Park SH, Ko MH, Seo JH. Recovery of brachial plexus injury after bronchopleural fistula closure surgery based on electrodiagnostic study: A case report and review of literature. World J Clin Cases 2022; 10(30): 11090-11100 [PMID: 36338209 DOI: 10.12998/wjcc.v10.i30.11090]
Corresponding Author of This Article
Da-Sol Kim, MD, Clinical Assistant Professor, Research Assistant Professor, Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, No. 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, Jeonju 54907, South Korea. dsolkim@jbnu.ac.kr
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2022; 10(30): 11090-11100 Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.11090
Recovery of brachial plexus injury after bronchopleural fistula closure surgery based on electrodiagnostic study: A case report and review of literature
Young-In Go, Da-Sol Kim, Gi-Wook Kim, Yu Hui Won, Sung-Hee Park, Myoung-Hwan Ko, Jeong-Hwan Seo
Young-In Go, Da-Sol Kim, Gi-Wook Kim, Yu Hui Won, Sung-Hee Park, Myoung-Hwan Ko, Jeong-Hwan Seo, Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, South Korea
Gi-Wook Kim, Yu Hui Won, Sung-Hee Park, Myoung-Hwan Ko, Jeong-Hwan Seo, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea
Author contributions: Go YI performed the electrodiagnostic study and contributed to the manuscript drafting; Kim GW, Won YH, and Park SH contributed to the data analysis; Go YI, Ko MH, Seo JH, and Kim DS contributed to the final diagnoses; Kim DS was responsible for the manuscript revision and intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Da-Sol Kim, MD, Clinical Assistant Professor, Research Assistant Professor, Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, No. 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, Jeonju 54907, South Korea. dsolkim@jbnu.ac.kr
Received: May 30, 2022 Peer-review started: May 30, 2022 First decision: July 29, 2022 Revised: August 5, 2022 Accepted: September 22, 2022 Article in press: September 22, 2022 Published online: October 26, 2022
Abstract
BACKGROUND
Axillary thoracotomy and muscle flap are muscle- and nerve-sparing methods among the surgical approaches to bronchopleural fistula (BPF). However, in patients who are vulnerable to a nerve compression injury, nerve injury may occur. In this report, we present a unique case in which the brachial plexus (division level), suprascapular, and long thoracic nerve injury occurred after BPF closure surgery in a patient with ankylosing spondylitis and concomitant multiple joint contractures.
CASE SUMMARY
A 52-year-old man with a history of ankylosing spondylitis with shoulder joint contractures presented with right arm weakness and sensory impairment immediately after axillary thoracotomy and latissimus dorsi muscle flap surgery for BPF closure. During the surgery, the patient was positioned in a lateral decubitus position with the right arm hyper-abducted for approximately 6 h. Magnetic resonance imaging and ultrasound revealed subclavius muscle injury or myositis with brachial plexus (BP) compression and related neuropathy. An electrodiagnostic study confirmed the presence of BP injury involving the whole-division level, long thoracic, and suprascapular nerve injuries. He was treated with medication, physical therapy, and ultrasound-guided injections. Ultrasound-guided steroid injection at the BP, hydrodissection with 5% dextrose water at the BP and suprascapular nerve, and intra-articular steroid and hyaluronidase injection at the glenohumeral joint were performed. On postoperative day 194, the pain and arm weakness were resolved, and a follow-up electrodiagnostic study showed marked improvement.
CONCLUSION
Clinicians should consider the possibilities of multiple nerve injuries in patients with joint contracture, and treat each specific therapeutic target.
Core Tip: We report a rare case of brachial plexus (division level), suprascapular, and long thoracic nerve injury after axillary thoracotomy and latissimus dorsi muscle flap surgery for bronchopleural fistula. The patient was diagnosed via the clinical course, magnetic resonance imaging, ultrasound, and electrodiagnostic study. This case recommends that clinicians should pay attention to patients’ underlying conditions, which are related to nerve complications such as severe multiple joint contractures, and prevent the complications.
