Brachial plexus injury: Following birthday bumps

Introduction

Brachial plexus injury following difficult delivery (Incidence varies between 0.15 and 3/1000 live births)^[1] and Road traffic accident is well known.^[2] Fractures and blunt Injuries following birthday bumps are reported in literature. However, to the best of our knowledge, brachial plexus injuries following the birthday bump has not been. The various anatomical presentations [Figure 1] after injury are avulsion, rupture, neuroma, or compression (neuropraxia).^[3,4] The prognosis for recovery from neuropraxia is efficient and quick. Recovery begins within 2–3 weeks after the injury occurs, and it is complete within 6–8 weeks.^[5]

Close

Figure 1

Various brachial plexus injuries

Export to PPT

Case Report

A 14-year-old male patient brought by parents in outpatient department with complaints of weakness along the left shoulder joint, prominent scapula and shooting pain, numbness along the shoulder and the arm along the C5, C6, and C7 distribution, next day after the onset of symptoms. The mechanism of injury was unknown to parents; initially, the patient hid the mechanism of injury. After assurance, the patient gave a history of beatings as birthday bumps around the back and shoulder joints.

Clinical examination revealed bruises along the shoulder, painful and restricted neck movements and deficit along the C5, C6, and C7 roots. There was winging of scapula [Figure 2], biceps weakness (power: 3/5), axillary nerve deficit (power: 0/5). Tinel's sign was positive initially, no progression of stimulation point over the time.

Close

Figure 2

Winging scapula

Export to PPT

X-ray showed no bony abnormality, minimal soft-tissue edema. Plane magnetic resonance imaging [Figures 3 and 4] showed edema along the brachial plexus with no anatomical discontinuity.

Close

Figure 3

Magnetic resonance imaging - Coronal image

Export to PPT

Close

Figure 4

Magnetic resonance imaging - Sagittal image

Export to PPT

Medically managed with short-term steroids (Dexamethasone 8 mg thrice daily for 7 days), nonsteroidal anti-inflammatory drugs (Naproxen 250 mg twice daily for 3 weeks), Pregabalin (75 mg twice daily for 2 weeks followed by once daily for the next 2 weeks), and Methylcobalamin (1500 mcg per day for 4 weeks). Immobilization with arm sling (ideally being the aeroplane splint for relaxation of the injured structures and prevention of contracture) done for 6 weeks, as it was easily available and the patient can attend school easily. Pain and swelling subsided after 3 days. The sensory deficits recovered after 3 weeks and motor deficit returned after 8 weeks. He was kept on physiotherapy with biceps strengthening exercises, shoulder range of movement, and abductor strengthening exercises for 6 weeks.

The patient recovered completely without any sequelae following 3 months after injury.

Discussion

“The bumps,” a birthday torment involves the friends and family of the person whose birthday it is taking, by the arms and legs, and “bumping” up into the air and down onto the floor. The number of “bumps” given equals the age of the person in years plus one “for luck.”^[6]

Physical and psychological trauma, various blunt injuries, and fracture have been repeatedly noticed due to it, Brachial plexus injury following birthday bumps has not been reported yet in literature. The common causes of the brachial plexus injury are birth injuries, clavicle fractures, shoulder dislocation, and other injuries around shoulder in road traffic accidents. Brachial plexus injuries 90% of the times are self-limiting with complete recovery.

Due to the pressure from family and higher authorities in schools and hostels the mechanism of injury, most of the time is concealed and attributed to accidental trauma. This distracts the physician from arriving at proper diagnosis when clinical signs are not obvious, or the clinical examination is not collaborating with the history given by the patients. This is only the tip of the iceberg in present-day life; we need to be ready with various accidental presentations in the name of selfie, stunts, or games (e.g., being the blue whale).^[7] which make adolescents exposed to the high risk of unexpected trauma.

College and hostel students must be counseled about the pros and cons of the various social evils so that similar injuries are avoided in future. There is a dire need of framing laws against practicing and publicizing such social evils by social media.