Abstract

Introduction: Peripheral neuropathy that compromises the brachial plexus have multiple causes. The prone position used in the management of patients with acute distress respiratory syndrome secondary to COVID-19 infection could cause injury to the brachial plexus.

Case Report: We report the case of a 62 year-old man who presented severe shoulder dysfunction after been managed for 7 days in prone position while receiving invasive mechanical ventilation in an intensive care unit. The patient was managed with neurorehabilitation, oral vitamin B complex and pregabalin with progressive but slow progress.

Discussion: The SARS-CoV-2 infection physiopathology on the peripheral nerve system is still not fully understood. Patients in the intensive care unit are susceptible to develop injuries to the brachial plexus mostly caused by the position of upper extremities. Prolonged use of prone position in patients with acute distress respiratory syndrome managed with invasive mechanical ventilation could cause injury to the brachial plexus. We stress the importance of actively looking for these injuries and take all the measures to prevent them.

Keywords: Prone Position; Brachial Plexus; Peripheral Nerve Injury; SARS-Cov-2 Infection

References

1. Mao L., et al. “Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China”. JAMA Neurology6 (2020): 683.
2. Memon AB., et al. “Suprascapular neuropathy: A review of 87 cases”. Muscle and Nerve3 (2019): 250-253.
3. Alhazzani W., et al. “Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)”. Intensive Care Medicine5 (2020): 854-887.
4. Chiumello D., et al. “Prone position in ARDS: a simple maneuver still underused”. Intensive Care Medicine2 (2018): 241-243.
5. Malik GR., et al. “Injury-Prone: Peripheral nerve injuries associated with prone positioning for COVID-19-related acute respiratory distress syndrome”. Intensive Care and Critical Care Medicine (2020).
6. Goettler CE., et al. “Brachial plexopathy after prone positioning”. Critical Care6 (2002): 540.
7. Li H., et al. “Involvement of the Nervous System in SARS-CoV-2 Infection”. Neurotoxic Research1 (2020): 1-7.
8. Ahmad I and Rathore FA. “Neurological manifestations and complications of COVID-19: A literature review”. Journal of Clinical Neuroscience 77 (2020): 8-12.
9. Alderden J., et al. “Risk factors for pressure injuries among critical care patients: A systematic review”. International Journal of Nursing Studies 71 (2017): 97-114.
10. Hussain G., et al. “Current Status of Therapeutic Approaches against Peripheral Nerve Injuries: A Detailed Story from Injury to Recovery”. International Journal of Biological Sciences 1 (2020): 116-134.
11. Kallet RH. “A Comprehensive Review of Prone Position in ARDS”. Respiratory Care11 (2015): 1660-1687.
12. Simpson AI., et al. “Reducing the Risk and Impact of Brachial Plexus Injury Sustained From Prone Positioning—A Clinical Commentary”. Journal of Intensive Care Medicine12 (2020): 1576-1582.

Citation

Citation: Felipe Cichero., et al. “Brachial Plexus Injury Secondary to Prolonged Prone Position in COVID-19 Pneumonia: Case Report".Acta Scientific Orthopaedics 4.1 (2021): 19-22.

Copyright

Copyright: © 2021 Felipe Cichero., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.