Brachial plexus neck 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.

Click here: Second Opinion Arthritis Treatment Kit

Brachial plexus neuritis is an uncommon cause of neck and arm pain. However, it should be on the list of potential possibilities in a patients where the clinical picture is not clear cut. The most disorder, brachial plexus neuritis is confused with is cervical radiculopathy (pinched nerve in neck).

Patients with acute brachial plexus neuritis present with a acute or subacute onset of pain followed by weakness of the upper arm and shoulder.

Cervical radiculopathy is the most common condition that can be confused with brachial plexopathy. These patients present with neck and arm pain due to a herniated disc or nerve root irritation from arthritis.

The time pattern of pain preceding weakness is important in establishing a diagnosis and differentiating acute brachial plexus neuritis from cervical radiculopathy. Patients with cervical radiculopathy present with simultaneous pain and neurologic deficit.

Damage to the brachial plexus can be due to other problems. Examples are trauma to the nerve, stretch injury, pressure exerted by malignancies in the area of the brachial plexus and damage that results from radiation therapy given for cancer.

A viral cause has been proposed as the cause of this problem. Up to 15 percent of cases have been reported to occur following vaccinations.

Most cases occur in men between the ages of 20 and 60 years.

Symptoms begin with acute, burning pain in the shoulder and upper arm with no well-defined cause. In most patients, the pain subsides over a few weeks, leaving the patient with residual weakness in the upper arm. This pattern of initial arm and shoulder pain followed by muscle weakness as the pain subsides is an important characteristic of acute brachial plexus neuritis.

The course of the neuritis is usually one of gradual improvement and recovery over several months. Some patients have persistent muscle weakness. A longer period of pain correlates with the degree of recovery.

Deformities can develop in the arm or hand with consequent muscle atrophy.

As mentioned earlier, the pain, weakness and neurologic abnormalities seen with cervical radiculopathy tend to occur simultaneously.

Tests that help with diagnosis are:

1. Nerve conduction test and electromyography (NCS/EMG).

2. Magnetic resonance imaging of the shoulder and upper arm musculature may reveal rapid nerve damage.

Conservative treatment may be initiated early on.

However, with progressive disease, corticosteroids may be recommended for cases that are caused by inflammatory issues.

Surgical decompression may be done for compressive problems.

Other drugs that have been used include non-steroidal anti-inflammatory medications and anti-seizure medications (such as phenytoin, carbamazepine, and gabapentin).

Physical therapy may be useful.

Recovery may be incomplete or complete and takes several months.

Complications include:

• Paralysis of the arm

• Loss of sensation in the arm and hand

• Deformity of the hand or arm

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