Bilateral axillary and suprascapular neuropathy after coronary artery bypass surgery

Neuropathies after coronary artery bypass (CABG) and cardiac surgery are usually transient and have been described fairly frequently. Our patient presented with an acute onset of a surprisingly symmetrical bilateral axillary and suprascapular neuropathy during the immediate CABG period (which to our knowledge has not been reported on before). The patient, aged 64 years, suffered from diabetes mellitus type 2 and hypertension, and underwent a triple CABG. Electroneuronographic and electromyographic examination confirmed the presence of the bilateral axillary and suprascapular neuropathy, which showed only minimal improvement 15 months later. The surmise is that the neuropathy developed as a result of compression or overstretching of the involved nerves during the surgical procedure, associated with suboptimal positioning of the arms. The 'hands-up position', with careful sternal retraction (Cooley retractor), may appear to prevent the posterior displacement of the shoulders and plexus injuries. The diabetes mellitus may have acted as an aggravating factor.