Medical Student Rush Medical College Chicago, Illinois, United States
Case Diagnosis: Left pan-brachial plexopathy
Case Description: The patient is a 47 year old male who required intubated secondary to COVID-19. After being extubated, the patient noted new left upper extremity weakness. MRI brachial plexus during hospital course with brachial plexitis. Outpatient electrodiagnostics with left severe pan-brachial plexopathy. Patient followed with neurology and was trialed on steroids due to concern of immune-mediated plexopathy (parsonage turner syndrome) with improvements in sensory symptoms. Patient subsequently started occupational and physical therapy and was fitted for a shoulder-elbow-wrist-finger orthosis. 3 months after initial exam, patient with gradual improvements in strength.
Discussions: The patient was hospitalized during 4/2020. The patient was intubated for 11 days with weakness first noted after extubation. The patient was given prednisone 60mg in late 5/2020 for one week, then tapered over 2 weeks. Patient noted improvement in sensory symptoms after steroid use. Patient also followed with PM&R and was started in PT and OT and given a referral for orthotics evaluation. Patient started therapy in 6/2020 and is currently active in therapy as of 8/2020. Patient’s initial 6/2020 OT evaluation with 2/5 finger flexion in digits 4 and 5, intact shoulder elevation, and 0/5 in other muscles tested. Muscle testing in 8/2020 with antigravity strength in ulnar innervated hand, active gravity eliminated movement in median hand, antigravity elbow flexion and extension, 2/5 shoulder abduction. In therapy patient has worked on active and passive ROM, mirror therapy, and neuromuscular stimulation.
Conclusions: The patient is a 47 year old male with left severe pan-brachial plexopathy after hospitalization for COVID-19. Etiology of plexopathy uncertain but concern for immune-mediated plexopathy (parsonage turner syndrome) vs ischemia vs less likely compression. Patient trialed on course of prednisone with improvements in sensory symptoms. With ongoing therapy, the patient’s strength showed continued improvements both proximally and distally.