(Kiosk 2) Left Medial Cord Plexopathy from Gun Shot Wound: A Case Report

Case Diagnosis: Left medial cord plexopathy

Case Description or Program Description: A 32 year old Male with history of multiple gunshot wounds to the left mid back and chest region 1 month prior with retained bullet in left supraclavicular area presented with a complaint of sharp, burning pain in entire left upper extremity. Patient had concomitant left 1st, 3rd, 4th, and 5th rib fractures, T3-T5 transverse processes fractures, left pulmonary contusion, and left hemopneumothorax. Physical exam was noted to have atrophy of left-hand intrinsic, forearm, and upper arm muscles, decreased sensation in all digits, 4/5 left shoulder abduction, elbow flexion/extension, wrist flexion/extension and 0/5 Left Abductor Pollicis Brevis, Flexor Digitorum Superficialis and Profundus. Nerve Conduction Studies and Electromyography revealed absent Ulnar sensory and motor responses, decreased amplitudes in median motor responses, abnormal spontaneous activity in First Dorsal Interosseous, Flexor Carpi Ulnaris, Flexor Digitorum Profundus, Abductor Pollicis Brevis, and chronic motor unit potential changes with decreased recruitment of the same muscles.

Setting: Outpatient electromyography lab

Assessment/Results: Nerve conduction and electromyography studies revealed isolated left medial cord brachial plexopathy with active denervation in that distribution.

Discussion (relevance): The gun shot wounds caused isolated damage to the medial cord of the brachial plexus whether through direct or indirect trauma. Indirect trauma could be caused by excessive heat transmission or shock wave to adjacent tissues. According to a study performed, medial cord lesions related to GSWs had poor outcomes with surgical and non-surgical intervention so it was recommended to avoid surgery unless pain management was an issue. Additionally supraclavicular lesions had poorer prognosis than infraclavicular lesions.

Conclusions: This is an interesting case report of multiple gunshot wound resulting in isolated medial cord brachial plexopathy. Due to the data related to these types of injuries, it is likely that patient will have poor functional recovery.