Author: Minas V.; Thomas A.
Abstract: We report a case of idiopathic brachial plexus neuritis (IBN) following laparoscopic excision of endometriosis. The differential diagnosis between this non-position-related neuritis and brachial plexus injury is discussed. Introduction: IBN was reported in 1948 by Parsonage and Turner and presents with shoulder girdle pain followed by profound weakness. The syndrome is of unknown aetiology and has been described as a potential post-operative complication. In gynaecology there exists a report of IBN following hysteroscopic surgery. In the post-operative patient the appearance of IBNsymptoms may lead to misdiagnosis as they can be attributed to brachial plexus injury (BPI) due to peri-operative patient positioning. Material and Methods: A 37-year-old woman underwent laparoscopic excision of endometriosis. The operation was performed in Trendelenburg position. The patient's head was kept in a neutral position and her arms were placed straight by her side. She had an initially uneventful r Results: Clinical examination revealed wasting and weakness of the infra-spinatus muscle i.e. likely isolated supra-scapular nerve palsy in keeping with IBN. Magnetic resonance imaging showed atrophy of supra-spinatus and infra-spinatus left shoulder muscles without evidence of nerve compression. Nerve conduction studies confirmed the diagnosis of IBN. Recovery was enhanced with physiotherapy. Discussion: IBNmay complicate laparoscopic gynaecological surgery. It can be transiently debilitating for the patient and
distressing for the surgeon, with potential medico-legal implications if misdiagnosed as BPI. The diagnosis must be based on history, clinical examination, absence of evidence of nerve compression in MRI and confirmation by electromyographic studies.
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