Brachial Plexopathy in the Setting of Long Covid: A Case Report

Case Diagnosis: Bilateral brachial plexopathy

Case Description or Program Description: 28-year-old male presenting with hand weakness, paresthesia and fatigue that persisted months after recovering from Covid-19 infection.

Setting: Outpatient

Assessment/Results: This patient tested positive for Covid-19 in 2021, which resulted in a 3-week intubation with proning protocol. He presented with hand weakness, paresthesia in the fourth and fifth digits, and fatigue 1 year later. Evaluation showed muscle atrophy of the left forearm and bilateral hand intrinsic muscles with bilateral claw-hand deformities. MRI brachial plexus and cervical spine were unremarkable. EMG showed bilateral brachial plexopathy at the lower trunk. Initial dynamometer testing exhibited grip strength of 30 lbs and 26 lbs on the right and left, respectively. He participated in aggressive occupational therapy, and grip strength improved to 64 lbs and 60 lbs, respectively, 1 year later. EMG 4 years later showed improved ulnar nerve motor responses, which were previously unresponsive.

Discussion (relevance): It was established that prone positioning in acute respiratory distress syndrome provided improved oxygenation and survival (Li et al). However, due to hyperinflammatory and neurotropic characteristics of the Sars-Cov-2 virus, damage to the brachial plexus can be exacerbated (Wu et al). There are accounts of post-COVID plexopathy in patients who were not prone, indicating that the virus itself can affect the central and peripheral nervous system through blood or neuronal pathways (Li et al). Current treatment options for plexopathy include hand therapy and splinting, and possible surgical intervention (Li et al).

Conclusions: Cases of brachial plexopathy after COVID infection have been documented with and without proning. After proning protocol for 3 weeks, this patient experienced symptoms of long covid and brachial plexopathy post-infection. With the use of EMG and clinical picture, he was diagnosed with brachial plexopathy in the setting of proning protocol and long Covid-19. He improved significantly with aggressive therapy.