Nonbrachial Plexopathy Diagnoses Seen in a Brachial Plexus Injury Specialty Clinic

A subset of patients referred to brachial plexus clinics are eventually diagnosed with conditions unrelated to the plexus. This study characterizes these individuals to provide insights into the types of patients encountered by referring clinicians and surgeons caring for brachial plexus injuries (BPIs).

A retrospective review of all new consultations at a quaternary multidisciplinary BPI clinic over a 10-year period was undertaken. Patients were included when their final diagnosis did not involve a brachial plexus lesion.

Of 1,415 new patient consultations, 99 (7%) were diagnosed with nonplexus conditions. The mean age was 47.1 years (SD, 20.4; 9 months to 88 years), and 61% were male. Nonplexus diagnoses included cervical spine pathologies (n = 18), isolated distal peripheral nerve lesions (n = 14), primary neurologic disorders (n = 12), mechanical shoulder dysfunction (n = 9), spinal cord injury (n = 4), transverse myelitis (n = 4), and psychogenic disorders (n = 4). A diverse group of 34 patients was diagnosed with other conditions, such as missed compartment syndrome, distal crush injuries, or otherwise unknown conditions not consistent with BPI. Fifteen (15%) patients underwent surgical intervention with our team, including tendon transfers (n = 7), nerve transfers (n = 5), arthrodesis (n = 3), exploration with neurolysis (n = 2), neurorrhaphy (n = 2), tumor resection involving a peripheral nerve (n = 2), and nerve biopsy (n = 1).

Approximately 1 in 14 patients referred for brachial plexopathy were ultimately diagnosed with a nonplexus condition. A considerable proportion of these individuals were still deemed to benefit from surgical treatment. These findings highlight the value of comprehensive evaluation and management by a multidisciplinary team. Improved recognition of conditions that mimic brachial plexopathy may lead to more accurate referral patterns and earlier, appropriate intervention.

IV case series, differential diagnosis study.