200 Section - C5–C6 Palsy Mimicking Massive Rotator Cuff Tear After Camel Dismount Injury: A Case Report

C5-C6 palsies may result from various traumatic mechanisms, including direct compression, traction or a “spurling” type mechanism. In this report, we discuss a unique case of C5-C6 palsy following a camel dismount whiplash injury.

Case Description:

A 55-year-old male was referred to orthopedics for suspected massive rotator cuff tear six weeks after sustaining an injury during camel dismount. He was holding the reins of the camel when it abruptly knelt, jerking his left arm and neck. He felt a “pop” in the region of the left neck and shoulder with acute onset shoulder weakness. At the time of assessment, he demonstrated grade 1 motor function in the deltoid. He was referred to the EMG clinic, where atrophy and weakness in the left C5 and C6 myotomes was noted. Electrodiagnostic studies demonstrated evidence of C5-C6 nerve root palsy with evidence of early reinnervation. MR-neurography of the brachial plexus demonstrated thickening and increased signal intensity of the C6 nerve root extending to the upper trunk and lateral cord. Rehabilitation was initiated with a focus on activating the affected muscles. His power improved to grade 4- at 7-month follow-up.

Discussions:

To our knowledge, this is the first reported case of brachial plexopathy related to camel riding. This case highlights how neurogenic injury can mimic primary shoulder pathology and underscores the importance of maintaining a broad differential diagnosis, particularly with atypical mechanisms of injury. It also emphasizes the value of returning to foundational anatomic principles when evaluating shoulder weakness.

Conclusions: Furthermore, this case illustrates the diagnostic utility of MR neurography in confirming electrodiagnostic findings. Early involvement of physiatry was instrumental in accurate electrodiagnosis and precise lesion localization through targeted brachial plexus imaging.