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Neuralgic Amyotrophy Attributed Incorrectly to Block-Related Injury: Understanding Errors in Clinical Reasoning
  1. Joseph M. Neal, MD*,
  2. Susan S. Porter, MD and
  3. Barry P. Wilson, DDS
  1. *Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA; †Department of Anesthesiology, Kansas City Orthopaedic Institute, Leawood; and ‡Mission, KS
  1. correspondence: Joseph M. Neal, MD, Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Ave (B2-AN), Seattle, WA 98101 (e-mail: Joseph.Neal{at}virginiamason.org).

Abstract

Objective We report a case of misdiagnosed neuralgic amyotrophy (brachial plexus neuritis, Parsonage-Turner syndrome). Our primary objective is to review the scientific basis for errors in clinical reasoning.

Case Report We herein report a patient in whom signs and symptoms compatible with neuralgic amyotrophy presented after shoulder surgery. The patient's brachial plexopathy was attributed incorrectly as a complication of interscalene brachial plexus block. The true diagnosis was made only after the patient developed neuralgic amyotrophy in the contralateral upper extremity after a subsequent shoulder surgery on that side, this time without a brachial plexus block.

Conclusions Cognitive bias may lead to errors in clinical reasoning and consequent misdiagnosis. Temporal proximity may falsely implicate regional anesthesia as the causative agent.

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Footnotes

  • The authors declare no conflict of interest.

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