Case

A 38 year old patient is admitted to the hospital after a gunshot wound to the right chest. The patient is awake and talking with bilateral and equal breath sounds and heart sounds. A chest X-ray shows that there are no fractures and no major internal bleeding. There is, however, muscle weakness in both pectoralis major and pectoralis minor.

Question 2/2 - What is your plan for this patient after removing the bullet?

Click on your selected option(s) below  (correct = 2, over-thinking = 3+)

Case Complete

Incorrect. There is little neurosurgery could do to repair or stabilize an injured nerve. In the case of a complete transection, surgically you would reconnect the nerve ends in the hope that some re-growing axons will find their way back to their correct target.

Correct! The nerve injury and resulting muscle weakness could be the result of contusion or inflammatory responses. If this is the case, muscle strength will return as the inflammation subsides. 

Incorrect. A standards X-Ray would have shown any bullet or bullet fragments impacting the spinal cord. If that were the case, you would also expect all muscles connected and distal to the spinal injury point to be affected, not an isolated pectoral musculature weakness.

Incorrect. Since there was no evidence on the X-Ray of penetration of the thoracic wall, heart injury is unlikely. Stress testing an traumatically injured heart would also not usually be appropriate.

Not yet. In the absence of any X-Ray evidence for bony injury or joint disruption that may necessitate an orthopedic repair, it is too early in the case management to be considering orthopedic repair of functional loss.

Correct! If the nerve injury does not rectify as inflammation subsides, physiotherapy can be used to restore range of motion or strengthen remaining connected muscle fibers and would be a first step in recovery after the acute injury stabilization.