Intraoperative Neuromonitoring for Brachial Plexus Neurolysis During Delayed Fixation of a Clavicular Fracture Presenting as Thoracic Outlet Syndrome: A Case Report. 2018

Bradley D Ashman, and Anurag Tewari, and Joshua Castle, and Samer S Hasan, and Sanjeev Bhatia
Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, Ohio.

METHODS Brachial plexopathy is a rare complication of nonoperatively treated clavicular fractures. We describe a 68-year-old man who presented with fracture-callus-induced acute brachial plexopathy and dynamic thoracic outlet syndrome after 9 weeks of nonoperative management for a clavicular fracture. He underwent fracture fixation with brachial plexus decompression via callus excision; intraoperative neuromonitoring was used to evaluate brachial plexus function. Postsurgery, his neurologic function recovered completely. CONCLUSIONS Intraoperative neuromonitoring is a useful tool for minimizing the risk of additional brachial plexus injury and determining the adequacy of neural decompression during delayed open reduction and internal fixation of clavicular fractures with fracture-callus-induced brachial plexus compression.

UI MeSH Term Description Entries
D008297 Male Males
D002968 Clavicle A bone on the ventral side of the shoulder girdle, which in humans is commonly called the collar bone. Collar Bone,Bone, Collar,Bones, Collar,Clavicles,Collar Bones
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D013901 Thoracic Outlet Syndrome A neurovascular syndrome associated with compression of the BRACHIAL PLEXUS; SUBCLAVIAN ARTERY; and SUBCLAVIAN VEIN at the superior thoracic outlet. This may result from a variety of anomalies such as a CERVICAL RIB, anomalous fascial bands, and abnormalities of the origin or insertion of the anterior or medial scalene muscles. Clinical features may include pain in the shoulder and neck region which radiates into the arm, PARESIS or PARALYSIS of brachial plexus innervated muscles, PARESTHESIA, loss of sensation, reduction of arterial pulses in the affected extremity, ISCHEMIA, and EDEMA. (Adams et al., Principles of Neurology, 6th ed, pp214-5). Costoclavicular Syndrome,Neurovascular Syndrome, Thoracic Outlet,Scalenus Anticus Syndrome,Thoracic Outlet Nerve Compression Syndrome,Aperture Syndrome, Thoracic Outlet,Arterial Thoracic Outlet Syndrome,Nerve Compression Syndrome, Thoracic Outlet,Neurogenic Thoracic Outlet Syndrome,Neurologic Syndrome, Thoracic Outlet,Superior Thoracic Aperture Syndrome,Thoracic Outlet Neurologic Syndrome,Thoracic Outlet Neurovascular Syndrome,Thoracic Outlet Syndrome, Neurogenic,Venous Thoracic Outlet Syndrome,Costoclavicular Syndromes,Outlet Syndrome, Thoracic,Outlet Syndromes, Thoracic,Syndrome, Costoclavicular,Syndrome, Scalenus Anticus,Syndrome, Thoracic Outlet,Syndromes, Costoclavicular,Syndromes, Thoracic Outlet,Thoracic Outlet Syndromes
D050723 Fractures, Bone Breaks in bones. Bone Fractures,Broken Bones,Spiral Fractures,Torsion Fractures,Bone Fracture,Bone, Broken,Bones, Broken,Broken Bone,Fracture, Bone,Fracture, Spiral,Fracture, Torsion,Fractures, Spiral,Fractures, Torsion,Spiral Fracture,Torsion Fracture
D019299 Decompression, Surgical A surgical operation for the relief of pressure in a body compartment or on a body part. (From Dorland, 28th ed) Surgical Decompression,Decompressions, Surgical,Surgical Decompressions
D064795 Intraoperative Neurophysiological Monitoring The systematic checking of the condition and function of a patient's CENTRAL NERVOUS SYSTEM during the course of a surgical operation. Intraoperative Neurophysiologic Monitoring,Intraoperative Neurophysiologic Monitorings,Monitoring, Intraoperative Neurophysiologic,Monitoring, Intraoperative Neurophysiological,Monitorings, Intraoperative Neurophysiologic,Neurophysiologic Monitoring, Intraoperative,Neurophysiologic Monitorings, Intraoperative,Neurophysiological Monitoring, Intraoperative

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