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Brachial Plexus Neuritis

Winged Scapula


Presentation

  • Retrospectively, two subgroups could be identified based on initial clinical presentation and EMG: one subgroup of patients presented with a compression neuropathy and the other subgroup presented with brachial plexus neuritis.[ncbi.nlm.nih.gov]
  • Patients with cervical radiculopathy present with simultaneous pain and neurologic deficits that fit a nerve root pattern. This differentiation is important to avoid unnecessary surgery for cervical spondylotic changes in a patient with a plexitis.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: This is the first reported case of coccidioidomycosis presenting with PNS involvement.[neurology.org]
  • We present a 19-year-old girl who developed a left brachial plexus neuritis following vaccination with a quadrivalent human papillomavirus (HPV) vaccine. Post-vaccination brachial plexus neuritis is a rare event.[ncbi.nlm.nih.gov]
  • We herein report the case of a 55-year-old man who presented with neuralgia, weakness, and muscle atrophy in his right shoulder girdle and upper arm, which progressed for ten months following a marine sports accident.[ncbi.nlm.nih.gov]
Arm Pain
  • Acute brachial plexus neuritis is an uncommon disorder characterized by severe shoulder and upper arm pain followed by marked upper arm weakness.[ncbi.nlm.nih.gov]
  • Brachial plexus neuritis (BN) is an uncommon disorder characterized by severe shoulder and upper arm pain followed by marked upper arm weakness.[diseasesatoz.com]
  • The typical history is sudden pain followed by marked muscle-weakness and wasting of the shoulder girdle and upper arm. Pain starts suddenly across the top of the shoulder-blade and lasts from a few hours to a fortnight.[shoulderdoc.co.uk]
  • Brachial plexus neuritis is an uncommon pathology characterized by severe shoulder and upper arm pain, followed by upper arm weakness. Brachial plexus neuritis most often affects the dominant shoulder of males.[healio.com]
  • Brachial Neuritis is the condition of sudden shoulder and arm pain, followed by weakness or numbness.[remedypainsolutions.com]
Skin Lesion
  • We describe a patient with a long history of rhinitis and a recent onset of asthma, who developed purpuric skin lesions, abdominal pain, eosinophilia and brachial neuritis along with evidence of sacral plexus neuropathy.[ncbi.nlm.nih.gov]
Shoulder Pain
  • Brachial plexus neuritis is thought to be an immune mediated inflammatory reaction resulting in acute onset of shoulder pain followed by muscle weakness and wasting.[ncbi.nlm.nih.gov]
  • It is researched that some individuals are more susceptible than others due to some genetic predisposition The signs and symptoms of Parsonage-Turner Syndrome include a gradual onset of shoulder pain that may be acute and severe.[dovemed.com]
  • DESIGN/METHODS: Case report RESULTS: A 23-year-old right-handed immunocompetent man presented with a 4-month history of right shoulder pain, followed by progressive right arm weakness, wasting and paresthesias.[neurology.org]
  • Brachial Neuritis is characterized by the acute onset of excruciating unilateral shoulder pain, followed by flaccid paralysis of shoulder and parascapular muscles.[diseasesatoz.com]
  • pain. ( 11087188 ) Miller J.D....McDonald T.J. 2000 14 Herpes zoster brachial plexus neuritis. ( 9101105 ) Fabian V.A....Kakulas B.A. 1997 15 Bilateral brachial plexus neuritis following parvovirus B19 and cytomegalovirus infection. ( 9007101 ) Maas[malacards.org]
Muscle Weakness
  • Brachial plexus neuritis is thought to be an immune mediated inflammatory reaction resulting in acute onset of shoulder pain followed by muscle weakness and wasting.[ncbi.nlm.nih.gov]
  • Numbness may occur, depending on the particular nerves affected, and usually is found in the nerve distribution corresponding to the maximal muscle weakness; however, numbness is rarely a prominent complaint.[diseasesatoz.com]
  • Clinical features include severe pain in the shoulder region which may be accompanied by MUSCLE WEAKNESS and loss of sensation in the upper extremity.[connects.catalyst.harvard.edu]
  • After a few weeks the constant pain goes away and is replaced by muscle weakness or atrophy in the upper arm. Brachial Neuritis also goes by the names neuralgia amyotrophy and Parsonage Turner Syndrome.[goldlawfirm.net]
Right Shoulder Pain
  • DESIGN/METHODS: Case report RESULTS: A 23-year-old right-handed immunocompetent man presented with a 4-month history of right shoulder pain, followed by progressive right arm weakness, wasting and paresthesias.[neurology.org]
Weakness of the Trapezius Muscle
  • Method for detecting weakness in the trapezius muscle. Patient is instructed to abduct the humerus in the frontal plane.[jaoa.org]
Hyporeflexia
  • There is hyporeflexia, neurogenic atrophy and loss of sensation.[medical-dictionary.thefreedictionary.com]
  • Suspect acute brachial neuritis if patients have severe supraclavicular pain, followed by weakness and hyporeflexia that develop within days and resolve over months. In most cases, do electromyography and MRI or CT. Treat the cause.[merckmanuals.com]
Cervicobrachial Syndrome
  • syndrome 2016 2017 2018 2019 Billable/Specific Code Type 2 Excludes cervical disc disorder ( M50.- ) thoracic outlet syndrome ( G54.0 ) Angiospasm (peripheral) (traumatic) (vessel) I73.9 ICD-10-CM Diagnosis Code I73.9 Peripheral vascular disease, unspecified[icd10data.com]
Limb Weakness
  • Its classical presentation involves painful progressive asymmetrical upper limb weakness with sensory abnormalities.[jnnp.bmj.com]
Monoplegia
  • A 78-year-old female with a 3-week history of herpes zoster of the C4, C5, and C6 dermatomes developed left upper arm monoplegia. She died from an acute myocardial infarction.[ncbi.nlm.nih.gov]

Workup

  • Clinical Testing and Workup Certain tests such as nerve conduction studies or electromyography can be used to assess the health of muscles and the nerves that control muscles.[rarediseases.org]

Treatment

  • If the clinical image and EMG suggest brachial plexus neuritis, a conservative treatment may be more appropriate.[ncbi.nlm.nih.gov]
  • There is often a history of viral illness, diagnosis is clinical, and treatment is supportive. Many sufferers are left with residual defects.[ncbi.nlm.nih.gov]
  • Recommended treatment and care needed for this condition: Specialized tests are necessary to confirm the diagnosis. Patients are under the treatment of neurologists and treatment entails large doses of steroids. Recovery can take up to 6 months.[shoulder.co.za]
  • Treatment includes analgesics and physical therapy, with resolution of symptoms usually occurring in three to four months. Patients with cervical radiculopathy present with simultaneous pain and neurologic deficits that fit a nerve root pattern.[ncbi.nlm.nih.gov]
  • Treatment : No specific treatment has yet been proved efficient in Neuralgic Amyotrophy. In the early stages, pain may require treatment. Common pan-killers are usually sufficient. As pain subsides, physiotherapy is recommended.[shoulderdoc.co.uk]

Prognosis

  • , distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis, and additional useful information HERE.[dovemed.com]
  • Early intervention is recommended for a good prognosis.[ncbi.nlm.nih.gov]
  • However, recent studies have indicated that the long-term prognosis of NA is less favorable than has been assumed.[ncbi.nlm.nih.gov]
  • Outcome: The prognosis is generally good, since recovery of strength and sensation usually begins spontaneously, as early as 1 month after symptoms onset, with about 75% of complete recovery within 2 years.[shoulderdoc.co.uk]

Etiology

  • More research needs to be conducted to confirm the pathogenesis and etiology of brachial plexus neuritis to further enhance clinicians' knowledge of this condition.[healio.com]
  • April 06, 2015 ; 84 (14 Supplement) April 23, 2015 Rahul Shah , Bing Liao , Elena Shanina , Glenn Smith First published April 8, 2015, Abstract OBJECTIVE: To emphasize Coccidioidomycosis as an unusual etiology for brachial plexitis BACKGROUND: Coccidioidomycosis[neurology.org]
  • Turner JC, Jackson H Jr, Parker FJ (1938) The etiologic relation of the eosinophil to the Gordon phenomenon in Hodgkin's disease. Am J Med Sci 195:27–32 Google Scholar 13. McNaught JB (1938) The Gordon test for Hodgkin's disease.[link.springer.com]
  • Pathology Etiology post radiation plexitis: usually presents 5-30 months after treatment, generally with doses of 6000 cGy viral brachial plexitis, e.g. cytomegalovirus, Coxsackie, herpes zoster, Epstein-Barr virus, parvovirus B19 immune-mediated toxic[radiopaedia.org]
  • It passes through the cervico-axillary canal in the neck, over the first rib, and into the axilla where it innervates the upper extremity (the brachium, antebrachium, and hand) as well as some muscles of the neck and shoulder. [2] Epidemiology/Etiology[physio-pedia.com]

Epidemiology

  • […] attacks resembling brachial plexus neuritis, special facial features, and cleft palate. ( 4428970 ) Erikson A. 1974 23 Canine brachial plexus neuritis: a syndrome resembling serum neuritis in man. ( 4748883 ) Cummings J.F....Washington L.D. 1973 24 Epidemiologic[malacards.org]
  • Epidemiology Brachial plexitis is more commonly seen in men between 30 and 70 years of age and is bilateral in 10-30% of patients 3.[radiopaedia.org]
  • Parsonage-Turner syndrome: clinical and epidemiological features from a hand surgeon’s perspective. Hand (N Y). 2016; 11(2):227-31. Complete Listing of References[spine-health.com]
  • It passes through the cervico-axillary canal in the neck, over the first rib, and into the axilla where it innervates the upper extremity (the brachium, antebrachium, and hand) as well as some muscles of the neck and shoulder. [2] Epidemiology/Etiology[physio-pedia.com]
  • […] winging (when long thoracic nerve involved) n euralgic amyotrophy (NA) or idiopathic neuralgic amyotrophy (INA) Parsonage-Turner syndrome (PTS) acute brachial neuropathy / neuritis / plexopathy / plexitis idiopathic brachial plexus neuropathy / neuritis Epidemiology[orthobullets.com]
Sex distribution
Age distribution

Pathophysiology

  • […] thoracic nerve - can cause scapular winging suprascapular nerve axillary nerve musculocutaneous nerve radial nerve other: cervical roots, anterior interosseous nerve (AIN), posterior interosseous nerve (PIN), lateral antebrachial cutaneous nerve (LABC) pathophysiology[orthobullets.com]
  • Clinical and pathophysiological concepts of neuralgic amyotrophy. Nat Rev Neurol. 2011;7(6):315-22. Watts G, Falder S, Rea S, Silbert P, Wood F. Parsonage- Turner syndrome in a major burns patient. Burns. 2009;35(7):1038-41. van Alfen N.[revistas.pucsp.br]
  • . • Although the exact pathophysiology is unclear, available evidence points to an autoimmune pathogenesis, superimposed on a mechanically-induced vulnerability of the nerves with an underlying genetic susceptibility. • Diagnosis of the classic form is[medlink.com]
  • Clinical and pathophysiological concepts of neuralgic amyotrophy. Nat Rev Neurol. 2011;10:315-322. Feinberg JH, Radecki J. Parsonage-Turner syndrome. HSS J. 2010;6:199-205. Van Alfen N, van der Werf SP, van Engelen BG.[rarediseases.org]

Prevention

  • […] individuals may have recurring conditions that may affect the quality of life Please find comprehensive information on Parsonage-Turner Syndrome regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention[dovemed.com]
  • Prevention Although damage to your brachial plexus often can't be prevented, you can take steps to reduce the risk of complications once an injury has occurred: For yourself.[mayoclinic.org]
  • Can brachial neuritis be prevented? Experts don’t know how to prevent brachial neuritis. The best thing you can do is avoid arm and shoulder injuries.[marshfieldclinic.org]
  • If the muscles are way too weak the patients need to wear a sling which will prevent dislocation of the shoulder. Apart from that it is essential to treat the underlying cause of the neuritis.[ic.steadyhealth.com]

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