Table 1

Characteristics, clinical presentation, prone positioning details and outcome

Patient 1Patient 2
Patient characteristicsAge (years)5558
EthnicityCaribbeanAsian British
BMI (kg/m2)2229
Diabetes?T1DM, (HBA1C 11.8%)T2DM, (HBA1C 6.0%)
Days on ICU1532
Hours in prone position (total)22101
Abduction of affected arm (hours)Total1955
Maximum continuous1011
Mean continuous9.56.86
Abduction of unaffected arm (hours)Total346
Maximum continuous310
Mean continuous35.75
Clinical featuresClinical presentationComplete flaccid paralysis of all muscles in left upper limb. Absent reflexes. Severe sensory loss distal to shoulder.Left wrist drop, bilateral intrinsic hand weakness.
EMGSevere acute denervation in left upper limb (first dorsal interosseous, extensor digitorum communis, extensor indicis, brachioradialis, triceps, biceps and deltoid) but normal EMG in pectoralis major and supra/infraspinatus. Sensory action potentials absent in left upper limb (median, ulnar, radial and medial antebrachial cutaneous) and left median and ulnar motor potentials small.Severe acute denervation in left triceps, extensor digitorum and pronator quadratus. Mild EMG abnormalities in many other muscles suggesting critical illness neuromyopathy. Sensory potential absent from left (normal on the right) radial. Sensory and motor potentials absent from the median and ulnar nerves bilaterally.
MRI c-spine and brachial plexusNormalNot done
(6 months)
  • BMI, body mass index; EMG, electromyogram; ICU, intensive care unit; MMN RODS, Multifocal Motor Neuropathy Rasch-built Overall Disability Scale (initially developed for use in multifocal motor neuropathy, we use this due to its ability to assess functional limitation in asymmetric upper limb weakness; 50 is normal while 0 means inability to perform any of 25 common activities); mRS, Modified Rankin Scale.