Brachial plexus palsy secondary to clavicular nonunion. Case report and literature survey

Compression neurapraxias of the brachial plexus secondary to nonunion of the clavicle are extremely rare. These palsies routinely affect the medial cord, producing primarily ulnar nerve symptoms. The nonunions that cause them are almost exclusively hypertrophic and are usually in the middle third of the clavicle. These palsies result from the entrapment of the medial cord of the brachial plexus within the costoclavicular space of Berkheiser. Onset of symptoms is highly variable. Treatment recommendations are divided between partial clavicular excision and open reduction with internal fixation. Because this lesion requires operative intervention, it must be carefully distinguished from traction palsy of the plexus for which it is easily mistaken. This distinction requires a meticulous neurologic examination during the initial evaluation of the patient with an acute calvicular fracture.