Chronic brachial plexopathy and axillary artery occlusion post shoulder trauma
Presentation
Motor bike accident about 5 years previously with impact of the right shoulder against a pole. Resultant scapular fracture. Subsequent chronic right hand paresthesia.
Patient Data
Bony irregularity at the root of the coracoid process is consistent with a healed fracture.
Assymetrical swelling and increased T2 signal in the right C5, C6, C7 and C8 nerve roots, trunks and cords of the brachial plexus on the right. All remain in continuity without signs of avulsion or "pseudo-meningocoele". Focal occlusion of the right axillary artery with reconstitution more distally by collaterals.
Case Discussion
This patient has both neurological and vascular causes for hand symptoms as a result of substantial trauma to the right shoulder (causing the coracoid process to be avulsed). Plexus changes are presumed to be due to traction at the time of injury with resultant scarring/edema but no avulsion. Arterial occlusion is likely to have occurred due to traumatic dissection.
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