gms | German Medical Science

Objectives/Interrogation: Brachial plexus injury (BPI) associated with thoracic surgery is a rare complication. We report the clinical feature of this condition and investigated the cause and pathophysiology.

Methods: Nine patients (8 males, 1 female) with BPI following thoracic surgery were included in the study. The mean age was 61.8 years (range 52-75). The affected side was right in 3 and left in 6 patients. Median sternotomy was performed in supine position for all patients and subclavian approach was indicated for 3 patients. We investigated the type of the palsy, clinical symptoms, factors to lead this condition, treatment and prognosis.

Results and Conclusions: The type of palsy was lower type BPI for all patients. Weakness of wrist extension and fingers flexion in 5 patients, and slight motor disturbances in 4 patients developed after the operation. Hypesthesia at the level of C7 or C8 in all patients and burning sensation in 3 patients developed postoperatively. Seven patients had the ipsilateral first rib fracture. Delay of motor nerve conduction velocity for ulnar nerve at ipsilateral cubital tunnel was found in 2 patients. All patients were treated conservatively. Pregabalin or duloxetine was administered for 3 patients who experienced burning sensation. Motor disturbances were recovered to MMT 5 in 6 patients and to MMT 4 in 3 patients after 3 - 6 months postoperatively. Sensory disturbances were recovered completely in 7 patients and slight numbness of ring and little fingers remained in 2 patients.

BPI was detected in 8 cases of 502 patients (1.6%) who underwent thoracic surgery with median sternotomy in our hospital. One case visited our clinic postoperatively from another hospital because of continuous sensory disturbance. We speculated that lower brachial plexus was compressed between first rib and clavicle due to excessive sternal retraction according with the fact that ipsilateral first rib fracture was found in 7 of 9 patients (77.8%). Before visiting our clinic, the influence of harvesting radial artery or continuous ulnar nerve compression at cubital tunnel during the surgery were suspected as the cause of the upper extremity symptoms.

After our instruction to the thoracic surgeons about this condition, diagnosis delay of BPI disappeared. All patients showed good recovery of motor and sensory disturbances within 6 months after the injury. We can contribute to prevention and early detection of BPI associated with median sternotomy by instruction to thoracic surgeons.