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  • Writer's pictureDr Josh Bonine DC

Combined Injuries

Combined Injuries


Traumatic events often result in numerous injuries creating similar symptoms of different conditions sometimes presenting a diagnostic dilemma. Spinal cord and peripheral nervous system injuries are a classic example Injury to the spinal cord and injuries to the peripheral nerves can result in similar signs and symptoms including pain, numbness, loss of sensation and muscle weakness.




Compliments of Medical Legal Art via The Doe Report (www.doereport.com). Copyright © 2012 Medical Legal Art, All rights reserved. A recent study by Rhee et al. (2011) looked at patients with either a brachial plexus injury or a combined brachial plexus injury and a spinal cord injury. The brachial plexus (peripheral nerves) originates in the cervical spine and supplies the arm and hand. The authors stated, “Accurate diagnosis of a brachial plexus injury or spinal cord injury is often delayed and obscured by the neurologic deficits caused by the other injury. In a patient who had sustained polytrauma that includes an overt spinal cord injury, the brachial plexus injury can be overlooked to the attention mandated for the more acute, life-threatening associated injuries or because the brachial plexus injury is erroneously and presumptively attributed to the spinal cord lesion” (Rhee et al., 2011, p. 2271).

The authors also said, “Physical examination and/or electrophysiological findings suggestive of a preganglionic injury were present in all of the patients with combined spinal cord and brachial plexus injury” (Rhee et al., 2011, p. 2274). This delay in diagnosis can adversely affect the prognosis and treatment plan for patients suffering from these injuries.


It is imperative that a complete history is elicited and a detailed neurologic and orthopedic examination is performed so a doctor, expert in trauma, can formulate an accurate diagnosis, prognosis and treatment plan for the patient. This will allow the doctor to correlate bodily injury and persistent functional loss.



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Reference:

Rhee, P. C., Pirola, E., H´ebert-Blouin, M. N., Kircher, M. F., Spinner, R. J., Bishop, A. T., & Shin, A. Y. (2011). Concomitant traumatic spinal cord and brachial plexus injuries in adult patients. The Journal of Bone and Joint Surgery, 93(24), 2271-2277.

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