A Stab Wound to the Axilla Illustrating the Importance of Brachial Plexus Anatomy in an Emergency Context: a Case Report
Main Author: | |
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Publication Date: | 2017 |
Other Authors: | , , , , , , |
Format: | Article |
Language: | eng |
Source: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Download full: | http://hdl.handle.net/10400.17/2593 |
Summary: | BACKGROUND:Although open injuries involving the brachial plexus are relatively uncommon, they can lead to permanent disability and even be life threatening if accompanied by vascular damage. We present a case report of a brachial plexus injury in which the urgency of the situation precluded the use of any ancillary diagnostic examinations and forced a rapid clinical assessment. CASE PRESENTATION: We report a case of a Portuguese man who had a stabbing injury at the base of his left axilla. On observation in our emergency room an acute venous type of bleeding was present at the wound site and, as a result of refractory hypotension after initial management with fluids administered intravenously, he was immediately carried to our operating room. During the course of transportation, we observed that he presented hypoesthesia of the medial aspect of his arm and forearm, as well as of the ulnar side of his hand and of the palmar aspect of the last three digits and of the dorsal aspect of the last two digits. Moreover, he was not able to actively flex the joints of his middle, ring, and small fingers or to adduct or abduct all fingers. Exclusively relying on our anatomical knowledge of the axillary region, the site of the stabbing wound, and the physical neurologic examination, we were able to unequivocally pinpoint the place of the injury between the anterior division of the lower trunk of his brachial plexus and the proximal portion of the following nerves: ulnar, medial cutaneous of his arm and forearm, and the medial aspect of his median nerve. Surgery revealed a longitudinal laceration of the posterior aspect of his axillary vein, and confirmed a complete section of his ulnar nerve, his medial brachial and antebrachial cutaneous nerves, and an incomplete section of the ulnar aspect of his median nerve. All structures were repaired microsurgically. Three years after the surgery he showed a good functional outcome. CONCLUSIONS: We believe that this case report illustrates the relevance of a sound anatomical knowledge of the brachial plexus in an emergency setting. |
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A Stab Wound to the Axilla Illustrating the Importance of Brachial Plexus Anatomy in an Emergency Context: a Case ReportHSJ CPRArm/innervationAxilla/injuriesAxilla/innervationBrachial Plexus/injuriesBrachial Plexus/physiopathologyBrachial Plexus Neuropathies/etiologyBrachial Plexus Neuropathies/physiopathologyBrachial Plexus Neuropathies/surgeryHand/innervationHypesthesia/etiologyHypesthesia/physiopathologyHypesthesia/surgeryMicrosurgeryTreatment OutcomeUlnar Nerve/injuriesUlnar Nerve/surgeryWounds, Stab/complicationsWounds, Stab/physiopathologyWounds, Stab/surgeryBACKGROUND:Although open injuries involving the brachial plexus are relatively uncommon, they can lead to permanent disability and even be life threatening if accompanied by vascular damage. We present a case report of a brachial plexus injury in which the urgency of the situation precluded the use of any ancillary diagnostic examinations and forced a rapid clinical assessment. CASE PRESENTATION: We report a case of a Portuguese man who had a stabbing injury at the base of his left axilla. On observation in our emergency room an acute venous type of bleeding was present at the wound site and, as a result of refractory hypotension after initial management with fluids administered intravenously, he was immediately carried to our operating room. During the course of transportation, we observed that he presented hypoesthesia of the medial aspect of his arm and forearm, as well as of the ulnar side of his hand and of the palmar aspect of the last three digits and of the dorsal aspect of the last two digits. Moreover, he was not able to actively flex the joints of his middle, ring, and small fingers or to adduct or abduct all fingers. Exclusively relying on our anatomical knowledge of the axillary region, the site of the stabbing wound, and the physical neurologic examination, we were able to unequivocally pinpoint the place of the injury between the anterior division of the lower trunk of his brachial plexus and the proximal portion of the following nerves: ulnar, medial cutaneous of his arm and forearm, and the medial aspect of his median nerve. Surgery revealed a longitudinal laceration of the posterior aspect of his axillary vein, and confirmed a complete section of his ulnar nerve, his medial brachial and antebrachial cutaneous nerves, and an incomplete section of the ulnar aspect of his median nerve. All structures were repaired microsurgically. Three years after the surgery he showed a good functional outcome. CONCLUSIONS: We believe that this case report illustrates the relevance of a sound anatomical knowledge of the brachial plexus in an emergency setting.BioMed CentralRepositório do Centro Hospitalar Universitário de Lisboa Central, EPECasal, DCunha, TPais, DIria, IAlmeida, MAMillan, GVideira e Castro, JGoyri-O'Neill, J2017-01-05T13:02:04Z2017-01-042017-01-04T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/2593engJ Med Case Rep. 2017 Jan 4;11(1):610.1186/s13256-016-1162-6info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:38:32Zoai:repositorio.chlc.min-saude.pt:10400.17/2593Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:19:56.437232Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
A Stab Wound to the Axilla Illustrating the Importance of Brachial Plexus Anatomy in an Emergency Context: a Case Report |
title |
A Stab Wound to the Axilla Illustrating the Importance of Brachial Plexus Anatomy in an Emergency Context: a Case Report |
spellingShingle |
A Stab Wound to the Axilla Illustrating the Importance of Brachial Plexus Anatomy in an Emergency Context: a Case Report Casal, D HSJ CPR Arm/innervation Axilla/injuries Axilla/innervation Brachial Plexus/injuries Brachial Plexus/physiopathology Brachial Plexus Neuropathies/etiology Brachial Plexus Neuropathies/physiopathology Brachial Plexus Neuropathies/surgery Hand/innervation Hypesthesia/etiology Hypesthesia/physiopathology Hypesthesia/surgery Microsurgery Treatment Outcome Ulnar Nerve/injuries Ulnar Nerve/surgery Wounds, Stab/complications Wounds, Stab/physiopathology Wounds, Stab/surgery |
title_short |
A Stab Wound to the Axilla Illustrating the Importance of Brachial Plexus Anatomy in an Emergency Context: a Case Report |
title_full |
A Stab Wound to the Axilla Illustrating the Importance of Brachial Plexus Anatomy in an Emergency Context: a Case Report |
title_fullStr |
A Stab Wound to the Axilla Illustrating the Importance of Brachial Plexus Anatomy in an Emergency Context: a Case Report |
title_full_unstemmed |
A Stab Wound to the Axilla Illustrating the Importance of Brachial Plexus Anatomy in an Emergency Context: a Case Report |
title_sort |
A Stab Wound to the Axilla Illustrating the Importance of Brachial Plexus Anatomy in an Emergency Context: a Case Report |
author |
Casal, D |
author_facet |
Casal, D Cunha, T Pais, D Iria, I Almeida, MA Millan, G Videira e Castro, J Goyri-O'Neill, J |
author_role |
author |
author2 |
Cunha, T Pais, D Iria, I Almeida, MA Millan, G Videira e Castro, J Goyri-O'Neill, J |
author2_role |
author author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Casal, D Cunha, T Pais, D Iria, I Almeida, MA Millan, G Videira e Castro, J Goyri-O'Neill, J |
dc.subject.por.fl_str_mv |
HSJ CPR Arm/innervation Axilla/injuries Axilla/innervation Brachial Plexus/injuries Brachial Plexus/physiopathology Brachial Plexus Neuropathies/etiology Brachial Plexus Neuropathies/physiopathology Brachial Plexus Neuropathies/surgery Hand/innervation Hypesthesia/etiology Hypesthesia/physiopathology Hypesthesia/surgery Microsurgery Treatment Outcome Ulnar Nerve/injuries Ulnar Nerve/surgery Wounds, Stab/complications Wounds, Stab/physiopathology Wounds, Stab/surgery |
topic |
HSJ CPR Arm/innervation Axilla/injuries Axilla/innervation Brachial Plexus/injuries Brachial Plexus/physiopathology Brachial Plexus Neuropathies/etiology Brachial Plexus Neuropathies/physiopathology Brachial Plexus Neuropathies/surgery Hand/innervation Hypesthesia/etiology Hypesthesia/physiopathology Hypesthesia/surgery Microsurgery Treatment Outcome Ulnar Nerve/injuries Ulnar Nerve/surgery Wounds, Stab/complications Wounds, Stab/physiopathology Wounds, Stab/surgery |
description |
BACKGROUND:Although open injuries involving the brachial plexus are relatively uncommon, they can lead to permanent disability and even be life threatening if accompanied by vascular damage. We present a case report of a brachial plexus injury in which the urgency of the situation precluded the use of any ancillary diagnostic examinations and forced a rapid clinical assessment. CASE PRESENTATION: We report a case of a Portuguese man who had a stabbing injury at the base of his left axilla. On observation in our emergency room an acute venous type of bleeding was present at the wound site and, as a result of refractory hypotension after initial management with fluids administered intravenously, he was immediately carried to our operating room. During the course of transportation, we observed that he presented hypoesthesia of the medial aspect of his arm and forearm, as well as of the ulnar side of his hand and of the palmar aspect of the last three digits and of the dorsal aspect of the last two digits. Moreover, he was not able to actively flex the joints of his middle, ring, and small fingers or to adduct or abduct all fingers. Exclusively relying on our anatomical knowledge of the axillary region, the site of the stabbing wound, and the physical neurologic examination, we were able to unequivocally pinpoint the place of the injury between the anterior division of the lower trunk of his brachial plexus and the proximal portion of the following nerves: ulnar, medial cutaneous of his arm and forearm, and the medial aspect of his median nerve. Surgery revealed a longitudinal laceration of the posterior aspect of his axillary vein, and confirmed a complete section of his ulnar nerve, his medial brachial and antebrachial cutaneous nerves, and an incomplete section of the ulnar aspect of his median nerve. All structures were repaired microsurgically. Three years after the surgery he showed a good functional outcome. CONCLUSIONS: We believe that this case report illustrates the relevance of a sound anatomical knowledge of the brachial plexus in an emergency setting. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-01-05T13:02:04Z 2017-01-04 2017-01-04T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/2593 |
url |
http://hdl.handle.net/10400.17/2593 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
J Med Case Rep. 2017 Jan 4;11(1):6 10.1186/s13256-016-1162-6 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
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BioMed Central |
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BioMed Central |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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