Brachial plexus inflammation arm pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Brachial plexus neuritis or neuropathy is an uncommon disorder with an unknown cause. It can easily be confused with other neck and arm conditions, such as cervical radiculopathy (pinched nerve in neck).

Patients present with a acute or subacute pain followed by weakness of the upper arm and shoulder.Patients with acute brachial plexus neuritis are often misdiagnosed as having cervical radiculopathy(pinched nerve in the neck).

Since pain in the cervical and shoulder area is a common problem, the list of potential causes is likewise long. Cervical radiculopathy is probably the most common condition.

Patients with cervical radiculopathy present with neck pain and neurologic deficits resulting from a disc herniation or arthritis.

One feature that differentiates brachial neuritis from cervical radiculopathy is the fact that pain precedes weakness. Patients with cervical radiculopathy present with pain and weakness occurring at the same time.

Other forms of damage to the brachial plexus can be due to trauma, stretch injury, tumors, and damage that results from radiation therapy for a condition like lung cancer.

A viral etiology has been proposed for some cases of brachial plexus neuritis.

Up to 15 percent of cases have been reported to occur following vaccinations, including hepatitis B vaccination. Some studies indicate that brachial plexus neuritis may be an immunologic disease.

Most cases occur between the ages of 20 and 60, although it's been reported in all age groups. Males are affected more than females.

The annual incidence has been estimated as 1.64 cases per 100,000 persons. Some patients present with bilateral acute brachial plexus.

The clinical onset is characterized by severe, acute, burning pain in the shoulder and upper arm with no obvious cause. In most cases, the pain subsides over the a few days to weeks, resulting in weakness in the upper arm. This pattern of initial arm and shoulder pain followed by muscle weakness as the pain gets better is an important characteristic of acute brachial plexus neuritis.

Among the common symptoms are:

• Shoulder pain.

• Numbness of the shoulder and arm.

• Tingling and burning.

• Weakness of the arm, hand, or wrist.

• If caused by a lung cancer, Horner's syndrome (eye drooping and decreased sweating in the face and small pupil)can be seen on physical exam.

The course is usually one of gradual improvement and recovery of muscle strength over a three to four months period. Some patients, however, experience several years of muscle weakness or even permanent weakness. In general, a longer length of pain means alonger length of weakness.

Examination shows abnormal reflexes.

Deformities may develop in the arm or hand, and atrophy may be seen.

Unlike brachial plexus neuritis, the pain, weakness and neurologic problems due to cervical radiculopathy tend to occur simultaneously.

Tests for brachial plexopathy are:

•Nerve conduction test and electromyography (NCV/EMG).

•Nerve biopsy.

Magnetic resonance imaging of the shoulder and upper arm musculature may reveal nerve damage within a few days. Electromyography done three to four weeks after the onset of symptoms, can also help confirm the diagnosis.

If there is no history of trauma to the area, conservative treatment should be instituted.

Surgical decompression of lesions that press on the nerve may help some patients.

Anti-inflammatory medications may help. Corticosteroids may be recommended for cases that are caused by inflammatory problems.

Other drugs to control pain include antiseizure medications (such as phenytoin, carbamazepine, and gabapentin) have been used with varying success.

If pain is severe, a pain specialist should be consulted.

Physical therapy exercises to maintain muscle strength may be useful.

Recovery may be incomplete and take several months.

Complications include:

• Partial to complete arm paralysis

• Partial to complete loss of sensation in the arm and hand

• Deformity of the hand or arm and contractures

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