Treatment of iatrogenic brachial plexopathy persisting for 3 years due to cervical foraminotomy using Korean medicine: A case report (CARE-compliant)

Abstract

Background

Extrinsic or iatrogenic brachial plexopathy often resolves spontaneously within six months. Although steroid therapy and rehabilitation interventions are employed in the management of brachial plexopathy, their efficacy remains limited with insufficient supporting evidence. Moreover, therapeutic options to improve symptoms after the natural recovery period are limited.

Case presentation

A 49-year-old Asian woman was admitted with a three-year history of right upper extremity weakness and pain. The patient was diagnosed with sequelae of iatrogenic right brachial plexus injury due to cervical foraminotomy based on the magnetic resonance imaging (MRI) of the right brachial plexus and medical history. The patient was treated with a comprehensive treatment regimen, including the herbal prescription Bojungikgi-tang, bee venom pharmaco-acupuncture, acupuncture, electroacupuncture, and electro-moxibustion. After 62 days of treatment, her motor strength, assessed using the modified Medical Research Council (MRC) scale, improved significantly from Grade 2.5 to Grade 4.5. The tolerated weight for dumbbells increased from 0.5 kg to 2 kg, and that for the weight bar increased from 0 kg to 2.07 kg. Pain intensity, measured using the Numerical Rating Scale (NRS), decreased from 5 to 1. The Shoulder Pain and Disability Index (SPADI) score markedly reduced from 81 to 23, and her performance in the Box and Block Test (BBT) improved from -6.24 to -2.82. Additionally, all domains of the Short Form Health Survey-36 (SF-36) reflected significant enhancement in the patient's physical and mental health.

Conclusions

This case suggests that combined treatment with Korean medicine might be an effective tool for treating brachial plexopathy symptoms. However, further studies are required to confirm the efficacy of this treatment.