Brachial plexus neuropathy
Brachial plexus neuropathy (BPN)
Description, Causes and Risk Factors:
A neurological disorder, of unknown cause, characterized by the sudden onset of severe pain, usually about the shoulder and often beginning at night, soon followed by weakness and wasting of various forequarter muscles, particularly shoulder girdle muscles; both sporadic and familial in occurrence with the former much more common; often preceded by some antecedent event, such as an upper respiratory infection, hospitalization, vaccination, or nonspecific trauma; usually attributed to a brachial plexus lesion, because the nerve fibers involved are most often derived from the upper trunk, but actually multiple proximal mononeuropathies.
Brachial plexus neuropathy is a well defined clinical entity characterized by acute onset of severe pain in the shoulder or arm. The pain is described as sharp, aching or burning, and can be severe enough to awaken the patient at night. Pain referred to the hand and scapular area have been reported. During the painful phase, the patient will avoid moving the shoulder and will hold the arm adducted and internally rotated with the elbow flexed. This antalgic position may mask the developing muscle weakness. In the majority of cases, the shoulder and arm pain persists for only a short duration (days to weeks), and as the pain subsides, muscle weakness and atrophy become evident.
Brachial plexus neuropathy has been described secondary to radiation therapy, trauma, infection, collagen diseases and vaccination. In the idiopathic form, the patient will often relate the onset of pain to a prior event, such as overexertion of the upper limbs; however, this is usually a red herring. The neuropathy may be the result of an immune-mediated inflammation, a hypersensitivity reaction, or an infectious disorder. Brachial plexus neuropathy can mimic several other conditions, resulting in misdiagnosis and mismanagement of the patient. This condition may be mistaken for rotator cuff tears and tendonitis, subacromial bursitis, impingement syndrome, cervical spine stenosis and disc herniation, upper extremity nerve entrapment, or malignant processes compressing or invading the brachial plexus.
Brachial plexus neuropathy has been reported in patients of all ages, but most commonly occurs between the third and seventh decades of life. Men are affected twice as frequently as women. The annual incidence is reported to be 1.64 per 100,000 population.
Pain usually affecting just one side of the body.
After a few hours or days, the pain transitions to weakness, limpness, or paralysis in the muscles of the affected arm or shoulder.
Lack of muscle control in the shoulder or arm.
Lack of sensation or feeling in the shoulder or arm.
Severe pain in the upper arm or shoulder.
Laboratory studies, cervical spine radiographs, myelogramsand CT scans may assist in diagnosis. Needle electromyographyof the affected muscles demonstrates fibrillation potentials,positive sharp waves, decreased recruitment and increased amplitude of motor unit potentials. These findings are consistent with axonal degeneration that results in flaccid muscleparalysis.
Neurologist may order certain tests to diagnose the condition. These tests may include:
Electromyography (to test the function of muscles and related nerves).
Magnetic resonance imaging (MRI) of the head, shoulder, or neck.
Nerve biopsy (a piece of a nerve is removed for analysis).
Nerve conduction tests (to determine how impulses are traveling through a nerve).
Most patients with brachial plexus neuropathy recover spontaneously despite the severity of initial symptoms and signs. Management is directed at symptomatic relief, preserving shoulder motion through active and passive exercises and re-assurance. Corticosteroids have been reported to help relieve pain, but other benefits remain questionable.
If nerve compression is causing your symptoms, surgery may be necessary. Underlying medical conditions such as diabetes and kidney disease may also need to be treated as these diseases can adversely affect nerves.
Avoiding cigarettes and alcohol, eating a healthy diet, and getting regular exercises can help many with various types of peripheral neuropathy, and brachial plexus neuropathy is no exception.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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