Brachial Neuritis

What is Brachial Neuritis?

Brachial neuritis (BN) is a condition that causes pain in the nerves carrying signals from the spinal cord to the arms, hands, chest and the shoulders. The brachial plexus is a network of nerves that passes through the shoulder and down the arm. When the brachial plexus gets inflamed or damaged, there can be pain and weakness in the shoulder, arm and hand. Inflammation of the sensitive nerves can cause sudden and severe pain.

BN is a unilateral condition as it affects only one side of the body.

Brachial Neuritis Types

There are certain types of BN that one can develop. Parsonage Turner Syndrome is a very rare type. This condition occurs when there is not any apparent injury to the shoulder although a diagnosis can be made. However, other tests are required to confirm the diagnosis of Parsonage-Turner Syndrome.

Picture 1 – Brachial Neuritis

The remaining types of BN are classified according to the cause of the condition. If injury is the reason, a patient is diagnosed with brachial plexus injury. This is the case for brachial neuritis which occurs due to accidents and contact sports. If no cause for the neuritis is found, it is classified as an acute condition.

Brachial Neuritis Symptoms

The pain usually starts in the shoulder and often in the upper arm. The pain is sudden and severe, which is characterized by one or more of the following:

• Sudden onset of pain without anything related to injury.
• Pain is described as piercing, sharp and radiating as opposed to a dull ache or throbbing pain.
• Pain that generally affects just one side of the body.
• After a few hours or days, the pain transitions to weakness, or paralysis in the muscles of the affected arm or shoulder.
• Lack of muscle control in the shoulder or arm.
• Lack of sensation or feeling in the shoulder or arm.
• Severe pain persists for several days, following which the arm becomes weak in various different muscles.
• Weakness in the arm is deep in nature, but usually gets better with time.

Brachial Neuritis Causes

Neuritis is a nerve inflammation. Naturally, BN can result in impairment of the functions which are served by the nerves of the brachial plexus. It is caused due to diverse conditions.

The causes are as follows:

• Autoimmune disorders, in which the tissues of the body are mistaken as foreign bodies and attacked by the immune system. Sometimes, these disorders can affect the nerves.
• Brachial plexus neuritis can result from gene mutation which affects skeletal development. Symptoms of brachial plexus neuropathy that begin in childhood is often the result of this genetic disorder.
• The nerves of the brachial plexus pass through openings in the cervical spine. These nerves can get injured by traumatic events such as falls, wounds or sports injuries. Another common athletic injury known as “Burner” or a “Stinger” occurs mostly in football players when the hard shoulders hits characteristics of game play. Direct blows drive the shoulder downward and the neck to the opposite side, thus stretching and compressing the nerves.
• A tumor can also put the nerves under pressure and lead to neuritis. Tumors that develop in the neck or upper shoulder can compress the cervical nerves which lead to the intense pain, muscle weakness and numbness of BN.
• Medical experts and researchers have seen that brachial plexus neuritis (which is of an extreme type) has been traced back to a viral cause.
• Certain infants are born with brachial disorders due to trauma experienced during birth. Some experts describe brachial plexus as an injury to the nerves of the arm during birth. Such injuries usually disappear with time. Sometimes, however, there is need of physical therapy.

Brachial Neuritis Diagnosis

Diagnosis is done after a long analysis of the medical history of a patient and his/her physical examination.

Magnetic Resonance Imaging (MRI) is often carried out in this case. Computerized tomography or CT myelogram is another common test which requires the usage of contrast dye to check the affected brachial plexus. Nerve conduction studies and electromyography are the other two diagnostic tests per to check the response of the nerves in the area. These two tests can be slightly and moderately uncomfortable. If the doctor finds other type of medical conditions related to another medical condition or illness he or she may ask the patient to conduct additional tests.

Brachial Neuritis Treatment

In the initial phase, inflamed brachial nerves can extremely painful. The initial course of treatment is usually concentrated on reducing the pain of sufferers.

Picture 2 – Brachial Neuritis Image

The treatment involves the following:

• Oral steroids, to reduce the inflammation.
• Rest or reduced activity.
• Narcotic medications for several days to control the severe pain.
• Neurotropic medications, such as Lyrica or Neurotin, should be started early in the course of the symptoms, as these medications can help control nerve membranes and control pain.
• Physical therapy for patients with this condition needs maintenance of full range of motion in the shoulder and other affected joints. Once the pain has been fully controlled, passive and active range of motion (ROM) exercises should be done. This is followed by the regional conditioning of the affected areas.
• Occupational therapy is another option where the functional conditioning of the upper extremity is helpful. Assistive devices and orthotics may be used on the basis of the particular disabilities present. An occupational therapist may be involved in maintaining ROM and strengthening, particularly if the hand and wrist are involved.
• Surgical Intervention involves nerve grafting or tendon transfers and maybe considered for the few patients who do not recover properly by 2 years.
• Since BN leads to the weakening of the deltoid muscle, which is one of the largest muscles in the shoulder, a physician tends to put the arm of a BN patient in a sling to prevent dislocation.