Brachial plexopathy

• Alternative Names

  Neuropathy - brachial plexus; Brachial plexus dysfunction; Parsonage Turner syndrome

• Causes, incidence, and risk factors

  Brachial plexus dysfunction (brachial plexopathy) is a form of peripheral neuropathy. It occurs when there is damage to the brachial plexus, an area where a nerve bundle from the spinal cord splits into the individual arm nerves.

  Damage to the brachial plexus is usually related to direct injury to the nerve, stretching injuries, pressure from tumors in the area, or damage that results from radiation therapy.

  Brachial plexus dysfunction may also be associated with:

  • Birth defects that put pressure on the neck area
  • Exposure to toxins, chemicals, or drugs
  • Inflammatory conditions, such as those due to a virus or immune system problem

  In some cases, no cause can be identified.

• Symptoms
  • Horner syndrome - possibly caused by a lung tumor that presses on the nerve
  • Numbness of the shoulder, arm, or hand
  • Shoulder pain
  • Tingling, burning, pain, or abnormal sensations (location depends on the area injured)
  • Weakness of the arm, hand, or wrist
    • Inability to extend or lift the wrist
    • Hand weakness
• Signs and tests

  Age and gender are important because some plexus problems are more common in certain groups (for example, young men more often have inflammatory brachial plexus disease).

  A neuromuscular examination of the arm, hand, and wrist will show a problem with the nerves of the brachial plexus. Arm reflexes may be abnormal. Specific muscle problems may indicate which portion of the brachial plexus has been damaged.

  Deformities may develop in the arm or hand, and there may be profound loss of muscle mass (atrophy).

  Tests that reveal brachial plexopathy may include:

  • Nerve conduction test and electromyography
  • Nerve biopsy
  • Special MRI views of the brachial plexus
• Treatment

  In some cases, no treatment is required and recovery happens on its own.

  If there is no history of injury to the area, then medication, braces or splints, and physical therapy may be recommended. Potent anti-inflammatory drugs (steroids) may be recommended for cases that are caused by inflammatory problems, such as brachial amyotrophy and brachial neuritis.

  Surgery may be needed if the disorder is long-lasting, symptoms get worse, or there are severe movement problems or signs of nerve fiber loss. Surgical decompression (removal of structures that press on the nerve) may help some people.

  Painkillers such as acetaminophen, aspirin, and ibuprofen may not help control nerve pain (neuralgia). Other medications may be used to reduce stabbing pains, including anti-seizure medications such as phenytoin, carbamazepine, and gabapentin. Tricyclic antidepressants, such as amitriptyline, may also provide pain relief. If pain is severe, a pain specialist should be consulted in order to make sure all options for pain treatment are considered.

• Expectations (prognosis)

  The likely outcome depends on the cause. Recovery takes several months and may be incomplete. Nerve pain may be quite uncomfortable and may persist for a long time.

• Complications
  • Deformity of the hand or arm, mild to severe, which can lead to contractures
  • 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 due to diminished sensation
• Calling your health care provider

  Call your health care provider if you experience pain, numbness, tingling or weakness in the shoulder, arm, or hand.

• Prevention

  Prevention is varied, depending on the cause.

• References
  Hammerstad JP. Strength and Reflexes. In: Goetz, CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 15.

Review Date: 9/22/2008

Reviewed By: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.