Brachial plexus injury caused by intraoperative positioning of hyperabduction and external rotation of upper extremity

Abstract

A 34-year-old man was admitted to our hospital for the resection of a large bulla. The bulla, which was 15 cm in diameter, existed in his left upper lung, with fluid retention. The patient was placed in the right lateral decubitus position with the upper arm abducted to 120 degrees and externally rotated, and we excised the bulla via a left anteroaxillary thoracotomy. The operation time was more than four hours because of the presence of strong adhesion. His left upper extremity was paralyzed immediately after the operation, and the intensity of his left brachial plexus incresed in the STIR image of MRI. Hyperabduction and external rotation of his left upper extremity were believed to have caused the brachial plexus injury based on the findings of neurological examination and MRI, and the prolonged operation time had a negative influence. His neurological symptoms were relieved after steroid therapy. To avoid brachial plexus injury, it is important to bring the upper arm into a more anterior plane than the body in the lateral decubitus position, and hyperabduction of the arm should be avoided as much as possible.