Orthopedics

The patient’s right upper extremity was held with shoulder internally rotated, elbow extended, wrist flexed, and forearm pronated. She demonstrated excellent triceps strength but had no biceps function. Moreover, she did not exhibit shoulder elevation or active wrist extension. The patient was referred for occupational therapy and splinting, with surgery ultimately deemed necessary.

Upon exploration of the right brachial plexus, the C6 nerve was found to have significant scarring and lack of stimulus conduction. There was contractility of the deltoid with stimulation at 2 mA of C5 proximally, but no contractility with stimulation of C6. The team proceeded with the procedure that included neurolysis of the brachial plexus and double fascicular nerve transfer.

At 2-year follow-up, the patient demonstrated significant improvement. She had regained shoulder elevation to above 130 degrees, full passive shoulder external rotation, negative clarion, active elbow flexion, supination to 10 degrees, no elbow flexion contracture, and some active extension of the wrist.

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