Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2015; 3(12): 984-987
Published online Dec 16, 2015. doi: 10.12998/wjcc.v3.i12.984
Simultaneous Erb’s and Klumpke’s palsy: Case report
Ashley Dawson, Eliana Vasquez, David Garrett Jr, Frank S Harris, Ibrahim M El Nihum, Samantha Dayawansa, Jason H Huang, Soren Singel
Ashley Dawson, Eliana Vasquez, Jason H Huang, Faculty of Medicine, Texas A and M University, Temple, TX 76502, United States
David Garrett Jr, Frank S Harris, Ibrahim M El Nihum, Samantha Dayawansa, Jason H Huang, Soren Singel, Department of Neurosurgery, Baylor Scott and White Health Care, Temple, TX 76508, United States
Author contributions: All authors contributed to this manuscript.
Institutional review board statement: This article meets the case report publication criteria, ethics requirements of Scott and White Health Care Temple, TX, United States.
Informed consent statement: Our institution does not need patient consent to publish a single case.
Conflict-of-interest statement: I am attaching a letter indicating that there aren’t any conflicts of intersts.
Open-Access: 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/
Correspondence to: Jason H Huang, MD, Department of Neurosurgery, Baylor Scott and White Health Care, 2401 S. 31st St, Temple, TX 76508, United States. jhuang@sw.org
Telephone: +1-254-7242475 Fax: +1-254-7245779
Received: November 11, 2014
Peer-review started: November 11, 2014
First decision: January 12, 2015
Revised: July 21, 2015
Accepted: August 13, 2015
Article in press: August 14, 2015
Published online: December 16, 2015
Abstract

Mapping nerve deficits during a physical exam after trauma to the upper extremity can help determine not only if the brachial plexus was injured but also which nerve roots were involved. A 28-year-old male presented with simultaneous signs and symptoms of Erb’s (C5) and Klumpke’s (C8, T1) palsy, with sparing of the C6 and C7 roots. The patient presented several months ago to his local emergency room with shortness of breath, which was determined to be caused by left diaphragmatic paralysis through clinical and radiographical evidence. However, the etiology of the current nerve dysfunction in the upper extremity remained unknown. With persistent questioning and establishing the patient’s trust in the caregivers, it was revealed that the patient had attempted suicidal hanging. We describe the clinical features and the likely mechanism of injury leading to this previously unreported combination of brachial plexus injuries. The unique injuries to this patient’s brachial plexus can be explained by the sequence of events during the attempted suicidal hanging. The upper brachial plexus was injured during the initial moments where the neck was excessively stretched and the lower brachial plexus was injured due to the patient reaching up and holding himself by his arm for an extended period of time.

Keywords: Erb’s palsy, Klumpke’s palsy, Hanging injury

Core tip: This report describes a unique case in which only the upper and lower roots of the left brachial plexus were injured, sparing the C6 and C7 roots. Careful questioning revealed that the injury was caused during an attempted suicidal hanging. The damage to C5 occurred due to stretching of the neck and the damage to the C7 and C8 roots occurred after the patient reached up to free himself and hung by his arm for a period of time.