Dr Zhi Yuan Eugene Koh1
1Royal Hobart Hospital, Hobart, Australia
It has been found that more than a third of acute burn patients develop some form of peripheral neuropathy, with a higher incidence in patients with a greater than 20% total body surface area burn.1 The most frequently diagnosed neuromuscular abnormality was found to be generalised neuropathy, and a brachial plexopathy was the fifth most common abnormality.2 A reported cause of brachial plexopathy in an acute burn patient is malpositioning of the patient either in the operating theatre or the intensive care unit.3
I present a series of three patients admitted to the Royal Hobart Hospital in the last ten years with more than 20% total body surface area burns. Two of whom developed bilateral upper limb weakness in the recovery period and the other developing unilateral upper limb weakness, with neurophysiological evidence of a brachial plexopathy, with no clear cause for a brachial plexus injury from the causative burn injury.
Brachial plexopathy can cause significant disability and can negatively impact the rehabilitation of a severe burns patient. Steps need to be taken to prevent avoidable causes of brachial plexus injury, such as positioning of the patient, and further study needs to be undertaken in the causes of peripheral neuropathy in an acute burn patient.
- Helm PA, Johnson ER, Carlton AM. Peripheral neurological problems in the acute burn patient. Burns. 1977;3(2):123-125.
- Helm P, Pandian G, Heck E. Neuromuscular problems in the burn patient: cause and prevention. Archives of physical medicine and rehabilitation. 1985;66(7):451-453.
- Kasahara T, Toyokura M, Furuno K, Ishida A. Bilateral brachial plexus palsies due to malpositioning after burn injury. Tokai J Exp Clin Med. 2007;32(1):1-5.
Dr Koh is the current unaccredited registrar at the Department of Plastic Surgery at the Royal Hobart Hospital