Rehabilitation Outcomes in a Patient with Brachial Plexus Injury and Multiple Comorbidities: A 7-Month Case Study

Abstract

Background: Brachial plexus injury secondary to prolonged prone positioning during COVID-19 hospitalization has emerged as a recognized complication, particularly in patients with metabolic comorbidities such as diabetes mellitus. Case Presentation: This case report describes the rehabilitation of a 31-year-old left-handed male with diabetes who developed brachial plexus injury following prolonged prone positioning during COVID-19 hospitalization. The patient underwent intensive physiotherapy over seven months, totaling 38 sessions. Clinical assessment included muscle strength testing, range of motion (ROM) measurement, balance evaluation, psychological distress assessment, the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, and the Brachial Assessment Tool (BrAT). At baseline, passive ROM was preserved; however, reduced muscle strength was noted in the shoulder flexors, extensors, abductors, and adductors, as well as in the elbow flexors and extensors. Intervention and Outcomes: A structured and progressive physiotherapy program was implemented. Over the rehabilitation period, improvements were observed in shoulder and elbow muscle strength, functional mobility, pain levels, QuickDASH scores, BrAT scores, and psychological status. Conclusion: This case highlights the multifactorial nature of neurological and functional recovery following brachial plexus injury associated with prolonged prone positioning. Mechanical factors, metabolic comorbidities, lifestyle influences, and psychological status may collectively affect rehabilitation outcomes. Intensive, structured physiotherapy may facilitate meaningful neurological and functional recovery even in complex clinical presentations.