| Brachial neuritis, or brachial neuropathy, is an inflammation of the nerves (neuritis) in the shoulder area (brachial nerves). In many cases the exact cause is unknown, but the condition may stem from an autoimmune reaction in which the body's own defenses are turned against a nerve complex in the neck and under the arm called the brachial plexus.
A form of brachial neuropathy called idiopathic brachial neuropathy is rare and occurs in an apparently healthy individual. For no apparent reason, the individual suddenly experiences shoulder pain and loss of use of an arm.
A specific form of brachial neuropathy called acute brachial neuropathy (also known as acute brachial radiculitis and Parsonage-Turner syndrome) has been diagnosed in individuals with fever following an infection.
Brachial neuropathy can result from traumatic injury to the network of nerves in the shoulder (brachial plexus). Such traumas include falling off a ladder, jerking the arm, having a tumor press down on the nerves, radiation therapy for cancer, and gunshot and stab wounds. Brachial neuropathy occasionally follows surgery (when the individual was in the prone position), viral infections, cervical nerve blocks, or injections of serum, vaccines, or antibiotics.Risk: Males are 2 to 4 times more likely to have the condition than females, and although the condition can occur at any time; young to middle-aged adults are most commonly affected (Ashworth). A disproportionate number of heroin addicts are afflicted with the condition. Incidence and Prevalence: For every 100,000 people, approximately 1.64 cases per year are seen in the US (Ashworth). |
Source: Medical Disability Advisor
| History: The history of the nontraumatic form of this condition is the sudden onset of a severe ache in the muscles of the shoulder and frequently the arm and neck. Although the pain usually occurs in the right shoulder, 10% to 30% of the time, it is bilateral. Pain is constant, intense, and unrelieved by rest and worsens at night. The intense phase of the pain may last for a few hours to several weeks, but some low-grade pain may continue for several months. Individuals may think they twisted their neck or pulled a muscle. Whether or not the pain subsides, numbness and muscle weakness in the arm and shoulder usually follow within 3 to 10 days. The individual may have a recent history of infection, injections, or vaccinations. The individual may lose the use of that arm. Physical exam: The affected arm may be hanging weakly or be held by the individual's other arm. The muscles of the shoulder and upper arm (deltoid, biceps, triceps, and serratus anterior muscles) may be partially or almost totally paralyzed. The arm muscles may have decreased reflexes, and the arm and shoulder may have decreased sensation. Tests: Imaging studies and needle electromyography (EMG) will confirm this diagnosis. The time of onset of symptoms is very important since needle EMG evidence of denervation takes at least 10 days and frequently 21 days, to develop following nerve injury. Thus, a negative needle EMG examination done within 10 days of the onset of symptoms should be repeated later. A 3-week interval is recommended in order to make certain that enough time has passed for needle EMG findings to be detectable. Brachial plexus neuropathy may have been diagnosed as an isolated inflamed nerve, suggesting local compression. EMG will determine whether this is correct or if the whole area is inflamed. Nerve conduction studies should be done to rule out peripheral neuropathy due to systemic diseases. Both needle EMG and nerve conduction studies are electrophysiological tests. |
Source: Medical Disability Advisor
| Brachial neuropathy is treated conservatively. While the pain is still present, pain relievers (analgesics) are given. The pain may be severe enough for chronic narcotic therapy. A short course of high-dose oral steroids may be given. If brachial neuropathy developed during rigorous exercise, the individual is told to stop exercising the affected arm. The individual is generally advised to avoid constantly supporting the arm in a sling because of the risk of a "frozen shoulder." If pain and arm numbness continues for some weeks, physical therapy with range of motion exercises is recommended. In the unusual circumstance that the condition persists for over 2 years, the surgeon may consider nerve grafting or tendon transfers to improve movement. |
Source: Medical Disability Advisor
| Full functional recovery is expected in most individuals, although recovery can be slow. Full recovery may take a year or longer. The muscle numbness and decreased sensation usually last from 6 to 12 weeks. Some individuals continue to have residual feelings of weakness, and others may continue to have winging of the shoulder blade (scapula) and poor shoulder muscle control. Following recovery, 5% of those affected may suffer a later return of the condition. Generally, there is a less favorable prognosis for bilateral disease than those afflicted in just one limb, and the upper trunk resolves better than the lower trunk. |
Source: Medical Disability Advisor
| Individuals who present with brachial neuropathy may require outpatient physical therapy at a frequency of 2 to 3 times a week for 4 to 8 weeks. The necessity for therapy depends on the degree of pain and weakness in the shoulder and upper arm.
The first goal of therapy is to control pain. This is accomplished through the use of a sling to provide support to the shoulder. Individuals also learn to support the arm on a pillow when sitting in a chair. These techniques decrease the strain experienced by the inflamed nerves by decreasing the amount of traction forces to the shoulder that occur when the arm hangs in a dependent position. For individuals whose pain is not easily relieved, a transcutaneous electrical nerve stimulation (TENS) unit may be provided. This technique employs a small device that emits intermittent electrical impulses through electrodes placed on the shoulder and/or neck. These impulses block the perception of pain by the brain.
The second goal of therapy is to maintain range of motion at the neck, shoulder, and elbow. Individuals perform gentle, active range of motion exercises for the neck, shoulder, and arm in a pain-free range.
The third goal of therapy is the restoration of strength in the shoulder and elbow. Initially, the therapist teaches isometric strengthening, progressing to resistance exercises once the physician feels that further injury to the nerves will not be sustained.
For individuals with persistent shoulder or elbow weakness, neuromuscular electrical stimulation (NMES) may be appropriate. This technique uses a small device that emits an electrical impulse through electrodes placed on the weakened muscles. The impulse is strong enough to produce a muscle contraction and minimize muscle atrophy. |
Source: Medical Disability Advisor
| Brachial neuropathy typically results in rapid upper extremity muscular weakness and numbness even as pain resolves. If pain persists despite treatment for brachial neuropathy, this may indicate an underlying disease condition or cause of injury that could require further workup. Obesity may make testing difficult to interpret and may prolong recovery. Severe breathing difficulty may occur due to phrenic nerve involvement in the absence of lung disease. |
Source: Medical Disability Advisor
| The otherwise healthy individual will be limited by the pain, numbness, and weakness of his or her arm, with the result that lifting, carrying, and reaching overhead may be restricted. If recovery continues slowly over 1 to 3 years, medium to very heavy work will not be possible. If nerve damage is significant and permanent, the individual may be permanently limited to modified duty. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- What type of brachial neuropathy was diagnosed?
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Is there a proven cause of diagnosis, or is the neuropathy considered idiopathic?
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Has individual had recent fever and infection?
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Has individual had any recent trauma to the arm or shoulder area? Radiation therapy? Gunshot or stab wound to the area?
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Has individual recently had surgery or injections in the area?
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Did individual have a sudden onset of severe aching in the shoulder? How long did it last?
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Has individual developed muscle weakness in the same shoulder and arm? Numbness in the arm?
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Are the reflexes decreased in the arm and/or shoulder? Is there paralysis in the shoulder or upper arm?
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Was an MRI or cervical spine and brachial plexus needle EMG done? Nerve conduction study?
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Were any changes in abnormalities found in electrodiagnostic studies after onset, as compared to later studies?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Has individual responded to conservative therapy?
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Did individual have a short course of oral steroids?
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How long have symptoms persisted?
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Is individual in physical therapy?
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Was individual evaluated for appropriateness of treatment at a multidisciplinary pain and functional restoration center?
Regarding prognosis:
- Did individual have full functional recovery or experience residual feelings of weakness?
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Did individual have winging of the scapula and poor shoulder muscle control?
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Source: Medical Disability Advisor
| Ashworth, Nigel L. "Brachial Neuritis." eMedicine. Eds. Benjamin M. Sucher, et al. 30 May. 2002. Medscape. 18 Jan. 2005 <http://emedicine.com/pmr/topic58.htm>. |
Source: Medical Disability Advisor
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