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]
CONCLUSIONS: This is the first reported case of coccidioidomycosis presenting with PNS involvement. [neurology.org]
Case Presentation This 55-year-old man presented with rapid onset interscapular pain radiating to both shoulders after strenuous endurance exercise on an exercise bike. He complained of breathlessness associated with the pain, on lying down. [jnnp.bmj.com]
[…] with bilateral acute brachial plexus with only one side being symptomatic. 13 Clinical Presentation The hallmark clinical presentation of patients with acute brachial plexus neuritis is severe, acute, burning pain in the shoulder and upper arm with no [aafp.org]
Entire Body System
- 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]
Pain is unaltered by neck or arm movements. Pain is spontaneous, often with no apparent cause. Gradual decrease in pain followed by marked weakness of upper arm. [aafp.org]
The degree of pain may be variable and some patients don't recall a significant painful episode. Then, a weakness of some of the muscles of the shoulder girdle and often of the arm develops. When the weakness appears, the pain usually stops. [shoulderdoc.co.uk]
In some cases, the pain may radiate down the arm and into the hand. [diseasesatoz.com]
Brachial Neuritis is the condition of sudden shoulder and arm pain, followed by weakness or numbness. [remedypainsolutions.com]
- Fatigue
Patients also develop a fatigue of the shoulder, particularly with overhead activities. In the acute phase the condition may resemble an acute frozen shoulder, calcific tendonitis or arthritis. [shoulderdoc.co.uk]
Long-term pain, fatigue, and impairment in neuralgic amyotrophy. Arch Phys Med Rehabil. 2009; 90(3):435-9. Milner CS, Kannan K, Iyer VG, Thirkannad SM. [spine-health.com]
• Insider arthritis tips that help you erase the pain and fatigue of rheumatoid arthritis almost overnight! • Devastating ammunition against low back pain... discover 9 secrets! • Ignored remedies that eliminate fibromyalgia symptoms quickly! [arthritis-treatment-and-relief.com]
Long-term pain, fatigue, and impairment in neuralgic amyotrophy. Arch Phys Med Rehabil. 2009 Mar. 90(3):435-9. [Medline]. Cup EH, Ijspeert J, Janssen RJ, Bussemaker-Beumer C, Jacobs J, Pieterse AJ, et al. [emedicine.medscape.com]
Long-term pain, fatigue, and impairment in neuralgic amyotrophy. Arch Phys Med Rehabil. 2009;90:435-439. http://www.ncbi.nlm.nih.gov/pubmed/19254608 Schreiber AL, Abramov R, Fried GW, Herbison GJ. [rarediseases.org]
Musculoskeletal
- 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]
Vaccines for tetanus, HPV, the flu, and other diseases have been linked to cases of brachial neuritis, a condition that causes severe shoulder pain, weakness, and even paralysis. [schmidtlaw.com]
Acute onset of excruciating unilateral shoulder pain, followed by flaccid paralysis of shoulder and parascapular muscles several days later. The syndrome can vary greatly in presentation and nerve involvement. [emed.ie]
[…] in the acute pain phase, motion does not tend to worsen pain Rotator cuff pathology shoulder pain persists despite development of shoulder weakness in INA, shoulder weakness tends to develop after acute pain phase and is often painless impingement signs [orthobullets.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]
- 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]
Within a few hours or days of the condition’s onset, affected individuals may experience muscle weakness, wasting (atrophy), numbness (hyperesthesia), and paralysis of the muscles of the affected shoulder and, in rare cases, muscles of the hand and fingers [diseasesatoz.com]
[…] of muscle weakness or a slight permanent weakness. [aafp.org]
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]
The patient is a 43-year-old farmer, shown 6 months after presenting with severe right shoulder pain and weakness. Note severe wasting of the right infraspinatus and deltoid and winging of the scapula. Same patient as above. [emedicine.medscape.com]
- 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]
Neurologic
- 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. [msdmanuals.com]
Clinical examination and follow-up For each patient, motor and reflex neuropathy impairment scores, a linear scale of weakness and hyporeflexia ( Dyck et al., 1980 ) were extracted for the upper and lower limbs at each encounter. [academic.oup.com]
- Limb Weakness
Its classical presentation involves painful progressive asymmetrical upper limb weakness with sensory abnormalities. [jnnp.bmj.com]
- Cervicobrachial Syndrome
[…] of non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change Code annotations containing back-references to G54.0 : Type 2 Excludes: M53.1 ICD-10-CM Diagnosis Code M53.1 Cervicobrachial [icd10data.com]
- Flaccid Paralysis of the Upper Extremity
paralysis of the upper extremity. [meeting.handsurgery.org]
- Hyperesthesia
Within a few hours or days of the condition’s onset, affected individuals may experience muscle weakness, wasting (atrophy), numbness (hyperesthesia), and paralysis of the muscles of the affected shoulder and, in rare cases, muscles of the hand and fingers [diseasesatoz.com]
Workup
Workup Laboratory studies are indicated in brachial neuritis only if systemic disease is suspected on clinical grounds. [emedicine.medscape.com]
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]
Other Pathologies
- Lymphocytic Infiltrate
Histology of the brachial plexus showed extensive lymphocytic infiltration, myelin breakdown, and preservation of axons without vasculitis. The cervical spinal cord showed perivascular lymphocytic cuffing and no anterior horn necrosis. [ncbi.nlm.nih.gov]
Treatment
If the clinical image and EMG suggest brachial plexus neuritis, a conservative treatment may be more appropriate. [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]
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]
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]
[…] recurrence is rare in non-hereditary cases factors associated with poor prognosis female gender lower trunk involvement upper trunk has best prognosis persistent pain and no motor function recovery by 3 months hereditary cases age has no effect on prognosis [orthobullets.com]
[…] syndromes Upper plexus Lower plexus Retroclavicular Anatomy: Divisions Usually associated with upper or lower plexus lesions Isolated lesions: Uncommon Infraclavicular Anatomy: Cords & Terminal nerves No regional differences in incidence, severity, prognosis [neuromuscular.wustl.edu]
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]
Etiology and Epidemiology Acute brachial plexus neuritis has been recognized as a distinct plexus disorder since the 1940s. [aafp.org]
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]
There was no evidence in the preoperative history of our patient nor in the postonset interview for this case report that any of the reported etiologic risk factors were present. [anesthesiology.pubs.asahq.org]
They are organised into groups, and further divided into clinical, etiological or histopathological sub-types. [orpha.net]
Epidemiology
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]
[…] 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]
[…] indicus Flexor pollicus longus Differential diagnosis: Other involvement of supraclavicular lower plexus Thoracic outlet syndrome, Neurogenic Pancoast syndrome Neuralgic Amyotrophy 10 Nosology: Also called Parsonage-Turner syndrome Brachial Neuritis Epidemiology [neuromuscular.wustl.edu]
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]
Pathophysiology
demographics males > females (range 1.5:1 to 11.5:1) middle-age (4th decade) ages 20-60 most common (average age 41), though any age can be affected (range 3-81 years old) unilateral involvement bilateral in 10-30% of patients (16% simultaneously) 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]
Pathophysiology Brachial neuritis (BN) exists in an inherited and an idiopathic form. [emedicine.medscape.com]
Clinical and pathophysiological concepts of neuralgic amyotrophy. Nat Rev Neurol. 2011;10:315-322. http://www.ncbi.nlm.nih.gov/pubmed/21556032 Feinberg JH, Radecki J. Parsonage-Turner syndrome. [rarediseases.org]
Prevention
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. [hopkinsmedicine.org]
[…] 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]
The process of the nerve healing itself takes time and your doctor may recommend physical therapy to prevent joint and muscle stiffness. [orthoinfo.aaos.org]