Brachial plexus neuropathy secondary to postoperative prone positioning for macular hole surgery

To report a case of unilateral brachial plexus neuropathy after prone positioning for macular hole repair.

Case report.

After 7 days of strict prone positioning post-macular hole surgery, a 60-year-old patient developed severe pain and weakness in the left arm. Neurologic examination, imaging, and electromyography showed that the patient developed a unilateral brachial plexus neuropathy. Her strength and pain quickly improved after hospitalization and treatment with intravenous solumedrol, pain control, and physiotherapy. Her best-corrected vision improved from 20/400 to 20/40, however, she was left with frozen shoulder syndrome.

After macular hole surgery, prone positioning with persistent abduction of the shoulder such that the patient's hands rest above the head may put patients at risk for a brachial plexus neuropathy. However, this risk may be minimized by the use of positioning assistive devices, reducing the duration in the prone position, instituting frequent breaks, and warning patients to look for signs of neuropathy.