Neuropathy - brachial plexus; Brachial plexus dysfunction; Parsonage-Turner syndrome; Pancoast syndrome
Brachial plexopathy is a form of peripheral neuropathy. It occurs when there is damage to the brachial plexus. This is an area on each side of the neck where nerve roots from the spinal cord split into each arm's nerves.
Damage to these nerves results in pain, decreased movement, or decreased sensation in the arm and shoulder.
Damage to the brachial plexus is usually from direct injury to the nerve, stretching injuries (including birth trauma), pressure from tumors in the area (especially from lung tumors), 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
- General anesthesia, used during surgery
- Inflammatory conditions, such as those due to a virus or immune system problem
In some cases, no cause can be identified.
Symptoms may include:
- Numbness of the shoulder, arm, or hand
- Shoulder pain
- Tingling, burning, pain, or abnormal sensations (location depends on the area injured)
- Weakness of the shoulder, arm, hand, or wrist
Exams and Tests
An exam of the arm, hand and wrist can reveal a problem with the nerves of the brachial plexus. Signs may include:
- Deformity of the arm or hand
- Difficulty moving the shoulder, arm, hand, or fingers
- Diminished arm reflexes
- Wasting of the muscles
- Weakness of hand flexing
A detailed history may help determine the cause of the brachial plexopathy. Age and sex are important, because some brachial plexus problems are more common in certain groups. For example, young men more often have inflammatory or post-viral brachial plexus disease called Parsonage-Turner syndrome.
Tests that may be done to diagnose this condition may include:
- Blood tests
- Chest x-ray
- Electromyography (EMG) to check the muscles and nerves that control the muscles
- MRI of the head, neck, and shoulder
- Nerve conduction to check how fast electrical signals move through a nerve
- Nerve biopsy to examine a piece of nerve under the microscope (rarely needed)
Treatment is aimed at correcting the underlying cause and allowing you to use your hand and arm as much as possible. In some cases, no treatment is needed and the problem gets better on its own.
Treatment options include any of the following:
- Medicines to control pain
- Physical therapy to help maintain muscle strength.
- Braces, splints, or other devices to help you use your arm
- Nerve block, in which medicine is injected into the area near the nerves to reduce pain
- Surgery to repair the nerves or remove something pressing on the nerves
Occupational therapy or counseling to suggest changes in the workplace may be needed.
Medical conditions such as diabetes and kidney disease can damage nerves. In these cases, treatment is also directed at the underlying medical condition.
A good recovery is possible if the cause is identified and properly treated. In some cases, there is partial or complete loss of movement or sensation. Nerve pain may be severe and may last for a long time.
Complications may include:
- Deformity of the hand or arm, mild to severe, which can lead to contractures
- 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
When to Contact a Medical Professional
Call your health care provider if you experience pain, numbness, tingling, or weakness in the shoulder, arm, or hand.
Chad DA, Bowley MP. Disorders of nerve roots and plexuses. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 106.
Waldman SD. Cervicothoracic interspinous bursitis. In: Waldman SD, ed. Atlas of Uncommon Pain Syndromes. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 22.