Brachial plexus traction injury?

Would like to hear some other opinions on a client I have started seeing recently. Two months ago she sustained an injury unlocking a heavy mechanism on a caravan (this is the best description she can give me) which should have had two people operating it. She felt a "pop" and then had pain which steadily got worse over the top of her left shoulder. She saw a PT a couple of times who did some needling which helped a little bit, and has now started at my clinic two months post injury. She describes burning over her upper shoulder area, and tingling in her whole arm, and says it feels heavy. The symptoms seem glove-like over the whole arm and hand. Her reflexes appear intact and she has decent strength but it is a bit weaker generally, possibly from pain inhibition however. She has normal neck range of motion now (this is what we worked on at first). Her CT says narrowing at C5/6 foramen on the same side but she also has a history of a whiplash injury. I can give her some relief by taping the shoulder into elevation from its dropped position but everything else either doesn't help or makes it feel worse (needling, attempts at postural exercises). She is in tears from the pain when she tries to work (nursing) and is only on Mobic. Any ideas???

I had a patient with a brachial plexus injury that happened when she fell backwards and grabbed onto something infront of her - pulling the arm and stretching the plexus. She was in agony to be honest and from my (allbeit limited) experience of dealing with them, recovery can take a long time and its important the patient knows that. Like you, i taped the shoulder into elevation to offer some relief but it only lasted a while before that position became painful too. Recovery was spontaneous but I left that place of work and don't know how she got on after the first few sessions.

I did an inservice presentation on them, its a powerpoint and might give you a few ideas but from my reading for it the jist of the principles of management were education and psychosocial support (as its a nasty long term injury), ROM exercises to prevent secondary injuries and pain management. For that you could try things like TENS, massage (might be an idea to start distally as massaging the shoulder could be pretty painful - whatever works best i guess), hydrotherapy and trigger pointing. Happy to send presentation to you if you PM me an email.

Hey there,

sounds interesting. Please assess the thoracic spine if you haven't already and see if there is any change with manual therapy to the area. Worth a shot if you haven't already. If it is a brachial plexus injury then it'll be slow like bobo said and you should be offering symptom relief as best you can. Did the CT cover the shoulder and thoracic spine? or just the Cx?

bit of food for thought there. Would love to hear how it all goes

Puddin