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Bilateral isolated C5 paralysis of the shoulder: Atypical presentation of a transdiscal C4-C5 cervical spine fracture
  1. Elisa Mareddu,
  2. Aurélien Traverso,
  3. Pietro Laudato and
  4. Stefan Bauer
  1. Orthopaedics and Trauma Surgery, EHC Morges, Morges, Switzerland
  1. Correspondence to Dr Elisa Mareddu; elisa.mareddu{at}


After a low-energy fall, an 83-year-old man presented with bilateral weakness of the upper arms without loss of sensation associated with a rigid cervical spine (ankylosing spinal disorder, ASD). Because of an atypical presentation during history, examination and initial imaging, a late diagnosis of a transdiscal C4-C5 fracture was made by dynamic radiographs. Anterior cervical discectomy and fusion were performed with delay. Strength improved from grade C to D (American Spinal Injury Association classification) after surgery. To our knowledge, this is the first description of a bilateral, isolated upper limb C5 paralysis without any loss of sensation caused by a transdiscal C4-C5 fracture. A high clinical and diagnostic index of suspicion is mandatory to make the diagnosis. We present three clinical ‘Awareness Criteria’ (1: recognition of ASD; 2: high index of fracture suspicion; 3: necessary imaging) helping clinicians to safely and promptly diagnose occult spinal fractures in ASD.

  • C5 paralysis
  • shoulder paralysis
  • Transdiscal spine fracture
  • cervical spine

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  • Contributors EM wrote the paper and follow the patient. AT supervised CR writing. PL operated the patient. SB: Concept of manuscript, keypoints ans corrections

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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