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Brachial plexopathy Causes and Risks:
Brachial plexus dysfunction (brachial plexopathy) is a form of peripheral neuropathy . It occurs when there is damage to the brachial plexus , an area where the nerve from the spinal cord splits into the individual arm nerves.
Damage to the brachial plexus is usually related to direct trauma to the nerve, stretch injury (such as jerking of the arm), pressure caused by tumors in the area of the brachial plexus, and damage that results from radiation therapy (such as for lung cancer ). It may be related to pressure caused by congenital abnormalities that affect the cervical ribs, tumors, or injury by toxins , chemicals, or drugs. In some cases, no cause can be identified (neuralgic amyotrophy). The mechanical factors (pressure) may be complicated by ischemia (lack of oxygen because of decreased blood flow) in the area.
Prevention:
Prevention is varies, depending on the cause.
Symptoms:
Signs and Tests:
Neuromuscular examination of the arm, hand, and wrist indicates brachial plexus dysfunction. Reflexes may be abnormal in the arm. Specific muscle losses may indicate the portion of the brachial plexus that has been damaged. Variable deformities may develop in the arm or hand, and loss of muscle mass (atrophy) may be profound. Detailed history may be needed to determine the possible cause of the neuropathy.
Tests that reveal brachial plexopathy may include: Tests are guided by the suspected cause of the dysfunction, as suggested by the history, symptoms presented, and pattern of symptom development. They may include various blood tests, X-rays, scans, or other tests and procedures.
Treatment:
Treatment is aimed at maximizing independence. The cause should be identified and treated as appropriate. In some cases, no treatment is required and recovery is spontaneous.
If there is no history of trauma to the area, conservative treatment is indicated by sudden onset, minimal sensation changes with no difficulty in movement, and no test evidence of nerve axon degeneration.
Systemic corticosteroids may be recommended for cases that are secondary to inflammatory lesions (such as brachial amyotrophy, and brachial neuritis).
Surgery may be necessary if the disorder is chronic (long term), if symptoms worsen, if there is difficulty with movement, or if there is evidence that the nerve axon has degenerated. Surgical decompression may relieve an entrapped nerve, or surgical removal of lesions that press on the nerve may help some cases.
Over-the-counter or prescription analgesics may be needed to control pain ( neuralgia ). Various other medications may be used to reduce the stabbing pains that some persons experience, including phenytoin, carbamazepine or tricyclic antidepressants such as amitriptyline. Whenever possible, medication use should be avoided or minimized to reduce the risk of side effects.
Physical therapy exercises to maintain muscle strength may be appropriate for some people. Orthopedic assistance such as braces, splints , or other appliances may maximize the ability to use the arm. Vocational counseling, occupational therapy, occupational changes, job retraining, or similar interventions may be recommended.
Prognosis:
The probable outcome is variable; recovery may be incomplete or complete. Recovery takes several months. Nerve pain may be quite uncomfortable and may persist for a prolonged period of time.
Complications:
- partial or complete arm paralysis
- partial or complete loss of sensation in the arm, hand or fingers
- recurrent or unnoticed injury to the hand or arm
- deformity of the hand or arm, mild to severe, leading to contractures
Call Your Healthcare Provider:
Call your health care provider if you experience pain, numbness , tingling , or weakness in the shoulder, arm, or hand.
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