Brachial plexus injury: An unusual devastating complication during hospitalization in intensive care unit

Abstract

Brachial plexus injury due to prolonged immobilization of the arms in a hyper-abducted position during intensive care unit (ICU) follow-up is uncommon. In this article, we present an unusual case of a 20-year-old male drug addict who sustained unattended brachial plexus injury in left upper extremity after being bound over the axilla tightly during ICU follow-up. He had progressive numbness and near-total immobility of the left upper extremity. Atrophy, loss of muscle strength, and absence of deep tendon reflexes were observed in left upper extremity. Electrodiagnostic studies showed lower trunk partial axonal involvement. After aggressive physical therapy, patient’s muscle function improved, showing full strength in all muscles innervated by median, ulnar, musculocutaneous, axillary and radial nerves. During followup of unconscious patients in ICU, clinicians and other staff should be more careful about restraining such patients by considering complications such as nerve injuries.