BACKGROUND Shoulder hemorrhage resulting in brachial plexus neuropathy is a
rare occurrence most often seen in cases of traumatic injury or anticoagul
ation therapy. We report a unique case of spontaneous brachial plexus hemor
rhage.
CASE DESCRIPTION This is the first report of a spontaneous shoulder hemorrh
age in which a 48-year-old jackhammer operator presented to the emergency d
epartment with a sudden onset of right shoulder pain and upper extremity pa
in and numbness. Imaging studies revealed a hematoma in the right axilla an
d chest wall. Without evidence of active bleeding or worsening neurologic d
eficit, this patient was treated conservatively with pain control and obser
vation and eventually experienced a full recovery. Had there been persisten
t neurologic deficit, however, surgical evacuation would have been indicate
d.
CONCLUSIONS Cases of, nerve compression caused by a hematoma should be anal
yzed on the basis of the severity of the neurologic deficit and not on the
underlying cause of bleeding. Conservative treatment may be indicated in ca
ses of:mild or improving neurologic deficit, but regardless of its etiology
, a hematoma that results in severe or worsening neurologic symptoms must b
e surgically evacuated to prevent permanent nerve damage. (C) 2000 by Elsev
ier Science Inc.