Brachial plexus neuropathy syndrome, also termed as brachial plexopathy, is a nerve disorder in the brachial plexus, a bundle of nerves from the spinal cord that separates in to individual shoulder and arm nerves. Since the brachial plexus nerves generally originate from the spine region, the syndrome is quite often misdiagnosed as a slipped/compressed disc or cervical spine disorder. Also being a rare nerve disorder, it is easily confused with other neck and upper extremity abnormalities. However, the condition is mainly characterized by acute onset of severe pain in the shoulder or arm, followed by regional muscle weakness. It is commonly seen in people of young age groups, affecting males and females evenly and often characterized by repeated, bilateral attacks.
Causes of brachial plexus neuropathy syndrome
Though the actual causes are unknown, there are a few probable factors that may contribute to its occurrence, which are given below.
- Trauma to the area
- Stretching injuries
- Parasitic infestation
- Congenital abnormalities
- Excessive exposure to toxins and radiations
- Viral infection, especially of the upper respiratory tract
- Bacterial infection like pneumonia, diphtheria, typhoid, etc.
- Certain vaccinations, including influenza, tetanus, diphtheria, tetanus toxoids, pertussis DPT, smallpox, etc.
- Systemic illness such as polyarteritis nodosa, lymphoma, systemic lupus erythematosus, temporal arteritis, Ehlers-Danlos syndrome, etc.
The intensity of shoulder or arm pain experienced by the patient may vary, and is initially mistaken for a strain or injury until the patient starts suffering from muscle weakness. However, besides nerve pain, there are many other symptoms, which are as follows:
Diagnosis of brachial plexus neuropathy syndrome
Since brachial plexus neuropathy is usually mistaken for some other nerve abnormalities
, several diagnostic tests
may have to be conducted to identify the condition. The doctor will conduct a neurological exam
of the patient in order to diagnose the complex or intricate nerve fibres in the affected area. Further, he may perform an MRI of the area to reveal physical changes in the nerves, and a nerve conduction test to determine the nerves that are not conducting signals properly and where exactly the breakdown in communication is occurring. Nerve biopsies can also be conducted to look out for any structural damage to the nerve.
The treatment mainly depends upon its underlying cause. If an injury is not the cause of the pain, medication, braces or splints, and physical therapy are the most recommended treatment options. For mild nerve pain, painkillers like acetaminophen, aspirin, and ibuprofen can be used. However, to reduce stabbing and intense pain, medications like phenytoin, carbamazepine, and gabapentin can be given to the patient. Tricyclic antidepressants, such as amitriptyline, are also effective in providing pain relief. Physical therapy, comprising simple arm and shoulder exercises, can also help in relieving the nerve pain. In severe cases, wherein the syndrome is long-lasting and symptoms get worse, a surgery may be performed to treat the condition.
Though brachial plexus neuropathy is not a life-threatening disorder, if left untreated, it can develop into long term weakness or paralysis along with contractures in the shoulder and arm. Hence, regular neurological exams are strongly recommended to keep track of the changes in the condition. In case the aforementioned treatment options do not prove to be helpful and with time the condition worsens, consult a neurologist to elucidate the case.