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Atrophy of the brachialis muscle after a displaced clavicle fracture in an Ironman triathlete: case report

DOI: 10.1186/1749-7221-6-7

Keywords: Displaced clavicle fracture, Ironman triathlete, muscular-atrophy, brachialis muscle, brachial plexus

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Abstract:

Lesions of the brachial plexus are known to occur after displaced clavicle fractures. The most common way to get a lesion of the brachial plexus is a high-energy trauma leading to traction injuries[1,2], whereas lesions of the medial and the posterior cord have been reported most frequently[3,4]. A bone fragment from a displaced clavicle fracture is described in only 1% of the cases as the causative factor[4]. In this report we describe the case of a lesion of both, the musculocutaneous and axillar nerve with subsequent atrophy of the brachialis muscle. Regarding the anatomy, the axillar nerve originates from the posterior cord, whereas the musculocutaneous nerve originates from the lateral cord, which is not known to be affected by such injuries very often. The additional fact that a lesion of the brachial plexus occurred a certain time after a displaced midshaft fracture of the clavicle makes the case even more interesting and remarkable.In the last two kilometres of the cycling split in an Ironman triathlon a highly trained athlete hit a duck in the street and fell on his right side. He felt a sharp pain in his right shoulder and had to stop the race. Due to a previous clavicular fracture on his left side, the rider was highly suspicious of having sustained a similar injury. He returned back home and put on his old figure-of-eight dressing from the last fracture, without consulting a physician. He continued his training of indoor cycling and running and had no problems. Two weeks later before starting his swim training he continued to feel pain in his right shoulder, radiating into the radial side of the forearm and into the fingers. The clavicular head of the deltoid muscle showed a decreased sensation to light touch. An X-ray revealed a displaced fracture of the right clavicle (see Figure 1Panel A) and the athlete was advised to get this fracture treated surgically. A pre-operative CT scan was performed to help determine surgical fixation choices (see Figure 1P

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