Brachial Plexopathy
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Definition
Brachial plexopathy is pain, decreased movement, or decreased sensation in the arm and shoulder due to a nerve problem.
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 (including birth trauma), 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.
References
Ensrud E, King JC. Plexopathy--brachial. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 134.
Review Date: 9/28/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; 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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Neuropathy - brachial plexus; Brachial plexus dysfunction; Parsonage Turner syndrome
Symptoms
- Numbness of the shoulder, arm, or hand
- Shoulder pain
- Tingling, burning, pain, or abnormal sensations (location depends on the area injured)
- Weakness of the shoulder, arm, hand, or wrist
Signs and tests
An exam of the arm, hand and wrist can reveal a problem with the nerves of the brachial plexus. Signs may include:
Deformity of the arm or hand
Difficulty moving the shoulder, arm, hand, or fingers
Diminished arm reflexes
Wasting of the muscles
Weakness of hand flexing
A detailed history may help determine the cause of the brachial plexopathy. Age and gender are important, because some brachial plexus problems are more common in certain groups. For example, young men more often have inflammatory or postviral brachial plexus disease called Parsonage Turner syndrome.
Tests that may be done to diagnose this condition may include:
Blood tests
Chest x-ray
Electromyogram (EMG)
MRI of the head, neck, and shoulder
Nerve conduction tests
Nerve biopsy (rarely needed)
References
Ensrud E, King JC. Plexopathy--brachial. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 134.
Review Date: 9/28/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; 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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Neuropathy - brachial plexus; Brachial plexus dysfunction; Parsonage Turner syndrome
Treatment
Treatment is aimed at correcting the underlying cause and allowing you to use your hand and arm as much as possible. In some cases, no treatment is required and recovery happens on its own.
Over-the-counter or prescription pain medications may be needed to control pain. Anticonvulsants (phenytoin, carbamazepine, gabapentin, and pregabalin), tricyclic antidepressants (amitriptyline and nortriptyline), or other medications (duloxetine) may be prescribed. Use the lowest dose possible to avoid side effects.
- Physical therapy may be recommended for some people to help maintain muscle strength.
- Orthopedic assistance may increase your ability to use your hand and arm. Such therapy may involve braces, splints, or other appliances.
- Vocational counseling, occupational therapy, occupational changes, job retraining, or other measures may be recommended.
Some patients with brachial plexopathy may benefit from surgery if nerve compression is the cause of the symptoms.
If other nerves are also affected, an underlying medical problem that can affect nerves should be considered. Medical conditions such as diabetes and kidney disease can damage nerves. In these cases, treatment is also directed at the underlying medical condition.
Expectations (prognosis)
The likely outcome depends on the cause. A good recovery is possible if the cause is identified and properly treated. In some cases, there may be a partial or complete loss of movement or sensation. Nerve pain may be severe 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.
References
Ensrud E, King JC. Plexopathy--brachial. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 134.
Review Date: 9/28/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; 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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Neuropathy - brachial plexus; Brachial plexus dysfunction; Parsonage Turner syndrome
Prevention
Prevention is varied, depending on the cause.
References
Ensrud E, King JC. Plexopathy--brachial. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 134.
Review Date: 9/28/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; 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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 9/28/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; 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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.