"Ruby" - Brachial Plexus Avulsion/Horner's Syndrome - Case of the Month

Ruby is a five-year-old mixed breed who escaped from her house and was hit by a car. When Ruby was evaluated at East Lincoln Animal Hospital, she was not walking on her front left leg. She held the paw in a flexed position but was unable to bear weight on it. She was not painful when the leg was palpated and did not have any feeling in the lower portion of the leg. Her left pupil was smaller than her right pupil. Other than being quiet and scared, she did not appear to have any other injuries.
Ruby was screened for internal injuries. She has chest x-rays taken to check for lung bruising and any other problems (such as diaphragmatic hernia). She also had her abdomen evaluated by ultrasound to check for a ruptured bladder and other possible injuries of the abdomen.  Her left front leg and shoulder were x-rayed to check for any possible fractures.  All of Ruby's x-rays and tests were normal.
We determined that Ruby had a condition called Brachial Plexus Avulsion. This is an injury in which the nerve roots under the armpit region have been torn away from their origin by trauma. The type of trauma that usually produces this injury is when the leg is pulled away from the body or a direct blow to the shoulder occurs. The typical appearance of a dog with a brachial plexus avulsion is a dog with a dropped elbow and a flexed wrist. The affected limb usually appears longer than the normal limb and there is no sensation in the lower part of the limb. About 55% of dogs with brachial plexus avulsion will also have a condition called Horner's syndrome (abnormal pupil size, protrusion of third eyelid, droopy lip). Treatment involves physical therapy to maintain muscle tone and protection from injury since many dogs will drag their wrist on the ground and damage the skin. In most cases, if function has not returned by 6 months, the limb is often amputated.

   This is the typical look of a dog with a brachial plexus injury.

Ruby was released with instructions for physical therapy and we planned to wait and see if her nerve function returned. When she was rechecked in 1 month, she was still not bearing weight on the paw but appeared to have some use/control of her wrist. Three months later she was using the leg 75% of the time. Six months later, Ruby has regained 95% of the function of the left front leg. If you were not looking for the fact that she had a severe nerve injury on the left front leg, you would never know that anything was wrong with her.


   Ruby - back to normal!

Ruby is case of the month because:

- She beat the odds - her nerve function returned and she is back to normal.
- Her owners did not give up on her!