325 - A Case of Pickleball-Associated Pan-Plexopathy

Case Diagnosis: Traumatic brachial pan-plexopathy

Case Description: A 59-year-old female presented with three weeks of right arm weakness following a mid-match collision with a pickleball net, resulting in a humeral fracture treated non-operatively and anterior-inferior glenohumeral dislocation status post reduction. On exam she had weakness throughout the entire arm most pronounced in the deltoid, biceps, triceps, and ulnar-innervated hand intrinsics with decreased sensation from the mid-humerus to fingertips. Nerve conduction studies showed 50% reduction of right medial and lateral antebrachial cutaneous sensory responses and diminished musculocutaneous and ulnar motor responses. Concentric needle EMG was notable for absent voluntary motor unit potentials at the right deltoid and EDC with signs of active denervation additionally observed at the infraspinatus, biceps, and FDS. At follow-up studies eleven weeks post-injury, the patient had regained partial strength in all tested muscles. Her nerve conduction studies were relatively unchanged; EMG demonstrated recovery of active voluntary recruitment with many polyphasic motor unit potentials.

Discussions: Three weeks after injury, electrodiagnostic studies demonstrated evidence of an incomplete brachial pan-plexopathy affecting the upper, middle, and lower trunks with acute axonal loss. Motor unit recruitment was widely reduced with the most severe findings at the right deltoid and extensor digitorum. Follow-up studies at eleven weeks post-injury supported resolving proximal conduction block, with noted interval recovery of voluntary recruitment, but substantial axonal loss despite signs of incomplete reinnervation. While these findings suggested a favorable prognosis, she developed secondary CRPS and was started on oral steroids with stellate ganglion block planned.

Conclusions: Pickleball is now the fastest-growing sport in the United States, inevitably accompanied by a rise in musculoskeletal injuries. To our knowledge, this is the first documented case of pickleball-associated brachial plexopathy that caused substantial morbidity in an otherwise healthy female.