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Neurological Rehabilitation

Respiratory Synkinesis in Post-Traumatic Brachial Plexopathy: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 5

    Poster Presenter(s)

  • Emi Hitomi, MD (she/her/hers)

    Resident Physician
    Cleveland Clinic Foundation PM&R Program
    Cleveland, Ohio

    • Co-Author(s)

  • JM

    John Morren, MD

    Program Director, Neuromuscular Medicine Fellowship, Cleveland Clinic
    Cleveland Clinic
    Cleveland, Ohio

Disclosure(s):
Emi Hitomi, MD: No financial relationships to disclose
Case Diagnosis: 20-year-old female with respiratory synkinesis after a traumatic brachial plexus (BP) injury.

Case Description or Program Description: 20-year-old female had several injuries following a motorcycle accident that included a dislocated right shoulder, degloving of the right extremities, and hematoma of the right neck. Right upper extremity (RUE) imaging showed a Bankart lesion, extensive soft tissue swelling, and no acute fractures. Cervical spine imaging showed signs concerning for right multi-level nerve root avulsions. Initial electrodiagnostic evaluation one-month post-injury showed complete denervation of the RUE encompassing C5¬–T1 myotomes and an isolated intact ulnar sensory response.

Setting: Neuromuscular Outpatient Clinic

Assessment/Results: Patient had minimal functional improvement of the RUE over subsequent months, correlated by signs of reinnervation in some RUE muscles on repeat electrodiagnostic evaluation. Surgical treatment was recommended, and patient sought a second opinion. Repeat electrodiagnostic evaluation, nine months post-injury, noted that along with signs of reinnervation, active denervation and chronic neurogenic changes in several muscles of the RUE, the latissimus dorsi (LD) motor unit action potentials were firing in synchrony with respiration. This was a sign of respiratory synkinesis (RS) in the right LD.

Discussion (relevance): Described in obstetric BP injuries, RS after a traumatic BP injury in adults is infrequent, having been described in a handful of case reports and series. To our knowledge, this is the first case of RS in the LD. Prior reports suggest phrenic nerve fibers from the anterior horn at the C4 nerve root reinnervates the peripheral muscles supplying what was once C5 myotome. However, LD is innervated by the thoracodorsal nerve with C7 predominance and thus this case may suggest a thoracic root mediated synkinesis, which has been documented in two obstetric BP injury cases and post-thoracotomy.

Conclusions: Respiratory synkinesis in the latissimus dorsi muscle after a traumatic brachial plexus injury may suggest a thoracic root mediated reinnervation.