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肱丛神经损伤伴术后中锁骨骨折的物理治疗管理:一例报告

The Physiotherapy Management of Postoperative Mid-shaft Clavicular Fracture With Brachial Plexus Injury: A Case Report.

作者信息

Rai Anjali, Sharath H V, Raghuveer Raghumahanti, Qureshi Moh'd Irshad

机构信息

Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

出版信息

Cureus. 2024 Aug 8;16(8):e66461. doi: 10.7759/cureus.66461. eCollection 2024 Aug.

Abstract

Traumatic brachial plexus injury (BPI) is a debilitating condition predominantly affecting young males, often resulting from traction or direct injuries. Due to the complicated neuronal network, the damage is often classified as preganglionic or postganglionic injuries. It includes upper-limb mobility impairments as well as reduced muscular strength and sensitivity. We discuss a case of a 30-year-old female who suffered a displaced mid-shaft clavicular fracture and BPI after a road traffic collision. The patient experienced significant pain, restricted movement, and sensory and motor loss in her left arm. Imaging studies revealed additional complications, including epidural collection and pseudomeningoceles. She underwent open reduction and internal fixation of the clavicle, followed by a structured rehabilitation program focusing on pain management, muscle re-education, and functional recovery. This case highlights the complexity of managing clavicular fractures with concurrent BPI, requiring a multidisciplinary approach involving imaging, surgical intervention, and comprehensive physiotherapy for optimal recovery and functional restoration. Rehabilitation strategies were employed to address the diverse symptoms, including multi-sensory strategies, sensory re-education, graded motor imagery rehabilitation, and gradual restoration of upper extremity (UE) range, strength, and endurance and to develop neuromuscular control. Effective management of clavicular fractures with BPI requires early diagnosis, surgical intervention, and structured rehabilitation to improve functional outcomes and quality of life.

摘要

创伤性臂丛神经损伤(BPI)是一种使人衰弱的疾病,主要影响年轻男性,通常由牵引或直接损伤引起。由于神经元网络复杂,损伤常被分为节前或节后损伤。它包括上肢活动能力受损以及肌肉力量和感觉减退。我们讨论一例30岁女性病例,该患者在道路交通事故后发生了锁骨中段移位骨折并伴有臂丛神经损伤。患者左臂经历了严重疼痛、活动受限以及感觉和运动丧失。影像学检查发现了其他并发症,包括硬膜外积液和假性脑脊膜膨出。她接受了锁骨切开复位内固定术,随后进行了以疼痛管理、肌肉再训练和功能恢复为重点的结构化康复计划。该病例凸显了同时处理锁骨骨折合并臂丛神经损伤的复杂性,需要多学科方法,包括影像学检查、手术干预和全面的物理治疗,以实现最佳恢复和功能重建。采用了康复策略来解决各种症状,包括多感官策略、感觉再训练、分级运动想象康复以及逐渐恢复上肢(UE)的活动范围、力量和耐力,并发展神经肌肉控制能力。有效处理合并臂丛神经损伤的锁骨骨折需要早期诊断、手术干预和结构化康复,以改善功能结果和生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a164/11380546/f08546c08fa0/cureus-0016-00000066461-i01.jpg

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