Brachial Plexopathy

Definition

Brachial plexopathy is decreased movement or sensation in the arm and shoulder due to a nerve problem.

Alternative Names

Neuropathy - brachial plexus; Brachial plexus dysfunction

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

• Shoulder pain
• Numbness of the shoulder, arm, or hand
• Tingling, burning, pain, or abnormal sensations whose location varies with the part of the plexus injured
• Weakness (decreased muscle strength, independent of exercise) of the arm, hand, or wrist.
  • Inability to extend or lift the wrist (wrist drop)
  • Hand weakness
• Horner's syndrome (eye drooping, small pupil, and decreased sweating in the face) -- possibly caused by a lung tumor compressing the plexus

Signs and tests

Neuromuscular examination of the arm, hand, and wrist indicates brachial plexus dysfunction. Reflexes may be abnormal in the arm. Specific muscle losses may indicate the portion of the brachial plexus that has been damaged.

Variable deformities may develop in the arm or hand, and loss of muscle mass (atrophy) may be profound. Detailed history may be needed to determine the possible cause of the problem.

Tests that reveal brachial plexopathy may include:

• Nerve conduction test and electromyography
• Nerve biopsy

Treatment

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

If there is no history of injury to the area, medication, braces or splints, and physical therapy may be recommended for certain patients. 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 patients.

Common painkillers, like 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 probable outcome is variable depending on the cause. Recovery takes several months and may be incomplete. Nerve pain may be quite uncomfortable and may persist for a prolonged period of time.

Complications

• 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
• Deformity of the hand or arm, mild to severe, which can lead to contractures

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.

•	Peripheral neuropathy
•	Brachial plexus
•	Radiation therapy
•	Muscle function loss
•	Contracture deformity