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March 1984

An Unusual Compressive Neuropathy

Author Affiliations

From the Department of Neurology, University of Nebraska, Medical Center, Omaha.

Arch Neurol. 1984;41(3):341. doi:10.1001/archneur.1984.04050150123032

Unfortunately, compressive neuropathies involving both upper and lower limbs still occur as a result of positioning during surgery. These cases are both underdocumented and frequently denied (J.F.A., unpublished data, 1980). We describe a patient with such a compressive neuropathy that resulted from unusual positioning during surgery.

REPORT OF A CASE  A 60-year-old, right-handed woman underwent a 4.5-hour laparotomy. To gain better abdominal exposure, her right forearm was suspended horizontally from the anesthesia screen. Postoperatively, she was found clinically and electromyographically to have a right axillary neuropathy with deltoid muscle paralysis.The cause of the compressive neuropathy was probably related to a combination of two factors: position and time. The patient's right forearm was suspended horizontally from the anesthesia screen above her neck with the right arm elevated to 90° for 4.5 hours. I speculate that with the arm in this position for the extended period of time, the right axillary

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