Brachial plexopathy
Key points
- Brachial plexopathy is decreased movement or sensation in the arm and shoulder, caused by impaired function of the brachial plexus (a bundle of nerves that control sensation and movement of the arm).
- Brachial plexus dysfunction (brachial plexopathy) is a form of peripheral neuropathy.
- Neuromuscular examination of the arm, hand, and wrist indicates brachial plexus dysfunction.
- The cause should be identified and treated as appropriate.
Alternative names
Neuropathy - brachial plexus; Brachial plexus dysfunction
Definition
Brachial plexopathy is decreased movement or sensation in the arm and shoulder, caused by impaired function of the brachial plexus (a bundle of nerves that control sensation and movement of the arm).
Causes, incidence, and risk factors
Brachial plexus dysfunction (brachial plexopathy) is a form of peripheral neuropathy. It occurs when there is damage to the brachial plexus, an area where a nerve bundle from the spinal cord splits into the individual arm nerves.
Damage to the brachial plexus is usually related to direct trauma to the nerve, stretch injury, pressure from tumors in the area of the brachial plexus, or damage that results from radiation therapy (therapy for some forms of cancer, such as lung cancer).
It may be related to congenital abnormalities that cause pressure on the cervical (neck) ribs and may also sometimes be associated with exposure to toxins, chemicals, or drugs.
Rarely, it is caused by an inflammatory condition. In some cases, no cause can be identified. The mechanical factors (pressure) may be complicated by ischemia (lack of oxygen caused by decreased blood flow) in the area.
Symptoms
- Shoulder pain
- Numbness of the shoulder, arm, or hand
- Tingling, burning, pain, or abnormal sensations whose location varies with the part of the plexus injured
- Weakness (decreased muscle strength, independent of exercise) of the arm, hand, or wrist.
o Inability to extend or lift the wrist (wrist drop)
o Hand weakness - Horner's syndrome (eye drooping, small pupil, and decreased sweating in the face) - possibly caused by a lung tumor compressing the plexus
Signs and tests
Neuromuscular examination of the arm, hand, and wrist indicates brachial plexus dysfunction. Reflexes may be abnormal in the arm. Specific muscle losses may indicate the portion of the brachial plexus that has been damaged.
Variable deformities may develop in the arm or hand, and loss of muscle mass (atrophy) may be profound. Detailed history may be needed to determine the possible cause of the problem.
Tests that reveal brachial plexopathy may include:
- Nerve conduction test and electromyography (NCS/EMG), which is a recording of the electrical activity of nerves and muscles
Written and revised by
Gerald Hurowitz, M.D.
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