Stretch Brachial Plexopathy
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《新英格兰医药杂志》
A 29-year-old man had a one-month history of weakness of the left hand and painful paresthesias involving the radial half of his palm, as well as the palmar aspect of his thumb and index and middle fingers. These symptoms developed immediately after the patient underwent a total colectomy for ulcerative colitis, during which he was positioned supine with both arms extended and abducted to accommodate intravenous access. Examination revealed a bluish discoloration of the radial half of the palm, as well as the palmar side of the thumb and index and middle fingers. The skin in this distribution was dry to the touch, did not sweat, and had fine, silvery scales (arrow). The skin of the ulnar half of the palm, the palmar aspect of the fourth and fifth fingers, and the dorsal side of the hand was soft, moist, and pink. Motor testing showed weakness of the biceps, flexor pollicis longus, finger extensors, and intrinsic muscles of the hand. Pronation and supination were minimally weak. Sensory testing revealed hypoesthesia to light touch and hyperesthesia to pinprick in the median-nerve distribution in the hand and in the radial aspect of the forearm. The left biceps reflex was absent. The left axilla was tender to palpation. Examination of the cervical spine revealed no abnormalities. Electromyography confirmed the presence of a moderately severe brachial plexopathy on the left side of the upper trunk, with minimal involvement of the lower trunk. The patient's pain responded to treatment with amitriptyline. His symptoms slowly improved, but weakness, hyperesthesia, and anhidrosis persisted at the time of last follow-up examination, three months postoperatively.
Judith Lynn Gorelick, M.D.
New Haven Neurosurgical Associates
New Haven, CT 06510
Judith Lynn Gorelick, M.D.
New Haven Neurosurgical Associates
New Haven, CT 06510