burner syndrome- brachial plexus

[tania]

I wanted to share with everyone an interesting Brachial Plexus case.

Last Thursday i saw a dog that is now in foster care following a HBC. She had been found approximately two days post, unable to move. She (Macy) was taken to emergency vet and dx with a brachial plexus injury. It was recommended that there was no hope (the owner did not want to pay for any treatment) and she was scheduled for euthanasia. The next day she was sent to a local rescue with no pain meds (they said she was not painful), a bandage on the right foreleg that had been stitched up and no x-rays of the neck. I received x-rays of the neck which were not the greatest and hard to read (and i am not a radiologist so asked for further x-rays). I saw her last friday and found the exam to be not the norm for brachial plexus’ that i have seen in the past.
My findings were as follows:
1. heavy panting
2. dog kept falling to the ground after two steps, to the non affected side
3. pain on extension of the RF GHJ, however with stabilization of the cervical/thoracic, no pain elicited
4. no withdrawl reflex present RFL
5. reflex present in the shoulder and elbow
6. muscle loss was mild in the infra/supra, biceps, triceps, extensors
7. not wanting to eat, drink or pee.

Following exam i sent the owner home with proper slinging of the forelimb, to avoid abrasions to the dorsal paw, LLL to suspected injury site, visit to new vet for x-ray of forelimb and cervical, and visit to rDVM for pain medications. (report today following two days of tramadol and gaba- dog is now eating, drinking, peeing and not panting!)

Two days later i got the report, there was a moderate fx to the spine of the scapula, and no obvious injury to the neck (with MRI recommended). The new rDVM recommended amputation as he felt there was no hope.

So now enter my new PT…we had a discussion tonight, as i mentioned it was a weird presentation (ie. not severe muscle wasting, elbow shoulder reflex intact).. so she mentioned Burner syndrome in humans.

From what i can understand this is over-stretching of the nerves in the brachial plexus (in humans) due to trauma (usually football contusions). quote below from sports medicine website
The most common mechanism of injury is the stretching of the brachial plexus from a blow to the head or shoulder. A football tackle can force the shoulder and clavicle downward, which forces the neck into extension on the same side and flexion on the other side (figure, (a)).This action causes a traction injury to the upper trunk of the brachial plexus.

Compression of the nerves is also possible. A direct blow to the area above the clavicle may force the edge of the shoulder pad into the side of the neck. Another mechanism of injury is cause sidebending (ear to shoulder) with rotation and extension of the cervical spine away from the blow. This leads to the compression of the brachial plexus (b).-

so does this not sound like what a dog would experience with a blow from being hit by a car?

So now when i see this dog on thursday, i am going to look a little deeper…my plan of action, more laser, manual therapy for compensations, trigger point work, testing if there is improvement of reflexes, test for any weight bearing and fingers crossed it is more burner syndrome!

Anyone with any thoughts on this and if they have a similar presentation, and some guidance on more treatment options
Tania

[lehughes]

Can't wait for your update on this case.
I find that sometimes, I learn more after I approach a case with a tentative or working diagnosis. I treat based on that and then based on how the dog responds, I learn more about whether I was right or whether I need to tweek my thoughts.
So, your working diagnosis and plan sounds good.
Keep us posted!
Cheers,
Laurie