Perioperative Nerve Lesions

A case of bilateral brachial plexus palsy due to shoulder braces

“…The unusually long duration of this patient's plexopathy symptoms would suggest the presence of complete nerve transection or avulsion (Seddon's neuronotmesis) in addition to focal axonal disruption in an intact nerve (Seddon's axonotmesis) [3,11].…”

“…Intraoperative brachial plexus palsies have been reported with various combinations of these positioning conditions [2][3][4][5][6]. The initial diagnosis of the loss of BP readings was that of monitor malfunction.…”

“…In 1945, Wright [12] published a study in awake volunteers showing neurovascular compromise with the abducted arm position. The postulated mechanism for neurovascular compromise with abduction alone is traction on the brachial plexus and compression of the subclavian artery and brachial plexus between the clavicle and first rib [3]. The ASA Task Force on the Prevention of Perioperative Peripheral Neuropathies indicated, in a practice advisory, that 93% of anesthesiologists surveyed agreed that limiting arm abduction to less than 90°might decrease risk of brachial plexus injury [13].…”

“…The ASA Task Force on the Prevention of Perioperative Peripheral Neuropathies indicated, in a practice advisory, that 93% of anesthesiologists surveyed agreed that limiting arm abduction to less than 90°might decrease risk of brachial plexus injury [13]. Case reports of brachial plexus palsy occurring with arm abduction less than 90° [3][4][5][6] and a cadaver study examining the biomechanics of nerve strain [14] suggest that even arm positions less than 90°of abduction still place some patients at risk for brachial plexus palsy.…”

“…The injury most commonly resolves within weeks to months but more severe injuries may produce permanent symptoms [2,3].…”