Brachial neuritis

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By Upinder K Dhand MD

Brachial neuritis is also known as or subsumes Neuralgic amyotrophy and Parsonage-Turner syndrome. -ed.

Brachial neuritis, also known as neuralgic amyotrophy, has a characteristic clinical presentation with sudden onset of pain in the shoulder region, followed by weakness and atrophy of shoulder girdle muscles. Clinical variants may include upper limb mononeuropathies, diaphragm paralysis, or lower cranial nerve involvement and are important to recognize in order to avoid unnecessary work-up or interventions. In this update, Dr. Upinder Dhand, Clinical Professor of Neurology at the University of Missouri in Columbia, Missouri, discusses typical and variant clinical features, diagnostic approach, and emerging role of immune therapy in patients with brachial neuritis.

Key Points

  • Brachial neuritis, also known as neuralgic amyotrophy or Parsonage-Turner syndrome, is clinically characterized by acute onset of severe pain in the shoulder and/or arm, followed within days and weeks by weakness, wasting, and variable sensory impairment due to involvement of the brachial plexus or its component nerves.
  • Frequent association with an antecedent event points to immune pathogenesis; however, CSF examination is usually normal, and diagnosis is based on EMG and nerve conduction studies, which help localize the lesion to the brachial plexus and distinguish the syndrome from peripheral focal neuropathy and cervical radiculopathy.
  • A familial form of brachial neuritis, hereditary neuralgic amyotrophy, occurs at a younger age, may cause recurrent or bilateral brachial plexopathy, and is associated with septin (SEPT9) mutation.
  • Management of brachial neuritis consists of pain control, physical therapy, and supportive treatment. There is anecdotal evidence for the benefit of corticosteroid or intravenous immunoglobulin treatment in the acute phase.
  • The clinical course of brachial neuritis is usually monophasic, with good recovery of function within 1 to 2 years in the majority of patients.