Brachial plexitis
Brachial plexitis, which can be acute or gradual in onset, typically presents with shoulder or upper arm pain, and sometimes progressive numbness or muscle weakness. It is associated with various conditions including diabetes, inflammation (neuralgic amyotrophy), malignancies like lung and breast cancer, post-radiation, or trauma. Diagnosis is aided by nerve conduction studies and electromyography. Management generally involves conservative approaches, with physical therapy being central to alleviating pain, improving functionality, and maintaining range of motion. Treatment techniques include electrical nerve stimulation and cryotherapy. Pain relief is primarily achieved using non-steroidal anti-inflammatory drugs like naproxen, and in some cases, adjunctive therapies like glucocorticoids or narcotics for severe pain are employed.
2024-01-05 14:53:25 - Editor
Introduction to Brachial Plexitis
Brachial plexitis may be acute or insidious. Acute brachial plexitis is usually characterised by pain in the shoulder or upper arm, while that of insidious onset can manifest as progressive pain, evolving numbness or weakness of selected muscles. Brachial plexitis is related to diabetes, inflammation (neuralgic amyotrophy), malignancy (Lung cancer, breast cancer), post-radiation or traumatic. Nerve conduction study and needle electromyography are helpful for diagnosis.
Management Approach
Management is usually conservative. Physical therapy is effective in reducing pain, weakness, improving functional status and preserving range of motion. Physical therapy techniques include transcutaneous electrical nerve stimulation, kinesiotherapy, deep dermal therapy, cryotherapy and functional electric stimulation. Analgesia is best achieved with non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs includes naproxen 500 mg twice daily. Also, glucocorticoids, such as, prednisolone up to 1mg/kg/day may also helpful as an adjunctive therapy. Narcotics, may also be required to manage patients with severe pain.
References
1- Mustafa R, Klein CJ, Martinez-Thompson J, Johnson AC, Engelstad JK, Spinner RJ, Crum BA. Recurrent Brachial Neuritis Attacks in Presentation of B-Cell Lymphoma. Mayo Clin Proc Innov Qual Outcomes. 2018 Dec;2(4):382-386.
2- Alhammad RM, Dronca RS, Kottschade LA, Turner HJ, Staff NP, Mauermann ML, Tracy JA, Klein CJ. Brachial Plexus Neuritis Associated
With Anti-Programmed Cell Death-1 Antibodies: Report of 2 Cases. Mayo Clin Proc Innov Qual Outcomes. 2017 Sep;1(2):192-197.
3- Expert Panel on Neurologic Imaging: Bykowski J, Aulino JM, Berger KL, Cassidy RC, Choudhri AF, Kendi AT, Kirsch CFE, Luttrull MD, Sharma A, Shetty VS, Than K, Winfree CJ, Cornelius RS. ACR Appropriateness Criteria® Plexopathy. J Am Coll Radiol. 2017 May;14(5S):S225-S233.
4- Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The effectiveness of neural mobilizations in the treatment of musculoskeletal conditions: a systematic review protocol. JBI Database System Rev Implement Rep. 2015 Jan;13(1):65-75.
5- Calvo-Lobo C, Unda-Solano F, López-López D, Sanz-Corbalán I, Romero-Morales C, Palomo-López P, Seco-Calvo J, Rodríguez-Sanz D. Is pharmacologic treatment better than neural mobilization for cervicobrachial pain? A randomized clinical trial. Int J Med Sci. 2018;15(5):456-465.
6- Aleve tablets (naproxen) [prescribing information]. Whippany, NJ:
Bayer; received 2020.