Post-operative Brachial Plexopathy Following Spindle Cell Carcinoma Excision of the Shoulder: A Diagnostic Challenge in a Resource-Limited Setting

Abstract

Spindle cell carcinoma is a rare, aggressive biphasic variant of squamous cell carcinoma with exceptionally low incidence in the shoulder region. We describe a 25-year-old male who developed isolated left upper limb weakness and complete sensory loss immediately after surgical excision of a histologically confirmed left shoulder spindle cell carcinoma. Symptoms progressed over the next 20 days. Clinical examination showed flaccid paralysis with absent sensation (touch, pain, temperature, vibration) in the entire left upper limb (C5–T1), consistent with brachial plexopathy. No MRI of the brachial plexus, electromyography, or repeat biopsy was available due to resource constraints. Laboratory findings revealed only mild anaemia; viral serology was negative. The patient was managed conservatively with analgesics, intravenous fluids, and physiotherapy. He was discharged stable on day 3 with outpatient oncology and neurology follow-up. This case illustrates the diagnostic dilemma of distinguishing iatrogenic intra-operative nerve injury from possible tumour recurrence or infiltration in the immediate post-operative period, particularly when advanced imaging is unavailable. It emphasises the need for pre- and post-operative neurological assessment and multidisciplinary care in resource-limited settings.