eMedicine Specialties > Physical Medicine and Rehabilitation > Peripheral Neuropathy

Brachial Neuritis: Differential Diagnoses & Workup

Author: Nigel L Ashworth, MBChB, MSc, FRCPC, Professor and Chief, Division of Physical Medicine and Rehabilitation, Glenrose Rehabilitation Hospital, University of Alberta
Contributor Information and Disclosures

Updated: Sep 16, 2009

Differential Diagnoses

Acute Poliomyelitis
Neoplastic Brachial Plexopathy
Adhesive Capsulitis
Polymyalgia Rheumatica
Amyotrophic Lateral Sclerosis
Rotator Cuff Disease
Cervical Disc Disease
Thoracic Outlet Syndrome
Cervical Radiculopathy
HIV Infection
Mononeuritis Multiplex

Other Problems to Be Considered

Anterior interosseous syndrome
Acute calcific tendonitis
Pack palsy
Sarcoidosis and other granulomatous infiltrations
Spinal cord tumor
Traumatic mononeuropathies

Workup

Laboratory Studies

  • Usually within the reference range
  • Only indicated if systemic disease is suspected on clinical grounds
  • Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) as nonspecific indicators of systemic disease
  • Antinuclear antibody (ANA) as a marker for connective-tissue disease
  • Human immunodeficiency virus (HIV) serology

Imaging Studies

  • Magnetic resonance imaging (MRI) or computed tomography (CT) myelogram scanning should be considered initially to rule out cervical radiculopathy (particularly C5/C6). MRI of the brachial plexus can help to rule out carcinomatous or granulomatous infiltration, if clinically indicated.4
  • A shoulder radiograph may be indicated to rule out specific shoulder pathologies.
  • A chest radiograph is not usually part of the initial workup; however, it can be useful to rule out sarcoidosis or other granulomatous disease, as well as Pancoast tumor.

Other Tests

  • Electrodiagnosis4,18,19,20,21
    • Electrodiagnosis should be considered initially to confirm neuropathic diagnosis and to rule out various other conditions (eg, radiculopathy, neuropathy, amyotrophic lateral sclerosis).
    • Specific localization can be made to various nerves.
    • Loss of sensory and motor amplitudes with relatively normal conduction velocity is frequent. Note, however, that this finding only begins to fall beyond the reference range after approximately 1 week.
    • Somatosensory evoked responses are not reliable for distinguishing radiculopathy from brachial plexus neuropathy, and F-waves are generally less helpful than routine conduction studies in localization.
    • Needle electromyogram (EMG) shows denervation (fibrillations, positive sharp waves, and/or motor unit potential changes) in affected muscles 2-3 weeks after onset; however, clinically uninvolved muscles also may show abnormalities. Approximately 50% of patients with unilateral clinical involvement demonstrate bilateral EMG abnormalities. EMG results for the paraspinal muscles usually are within the reference range. Electromyographic exclusion of a radiculopathy may be challenging. In addition, strict anatomic localization often is difficult.
    • Proximal conduction block has been reported in brachial neuritis; however, this finding should suggest focal forms of inflammatory demyelinating diseases. Proximal slowing also may occur from loss of large fibers, regenerating fibers, and/or segmental demyelination.

Procedures

  • Nerve biopsy usually is not indicated in brachial neuritis. Axonal loss rarely is identified with biopsies of the radial sensory branch.
  • Lumbar puncture usually is not indicated. Analysis of cerebrospinal fluid generally is within the reference range in individuals with brachial neuritis.

More on Brachial Neuritis

Overview: Brachial Neuritis
Differential Diagnoses & Workup: Brachial Neuritis
Treatment & Medication: Brachial Neuritis
Follow-up: Brachial Neuritis
Multimedia: Brachial Neuritis
References
Further Reading
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References

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Keywords

brachial neuritis, shoulder pain, plexus, neuritis, brachial plexus, brachial plexopathy, plexus neuritis, Parsonage-Turner syndrome, acute brachial neuropathy, acute brachial plexitis, acute brachial radiculitis, acute shoulder neuritis, brachial plexus neuropathy, cryptogenic brachial neuropathy, idiopathic brachial plexopathy, idiopathic brachial neuritis, localized neuritis of the shoulder girdle, localized nontraumatic neuropathy, multiple neuritis of the shoulder girdle, neuralgic amyotrophy, paralytic brachial neuritis, serum neuritis, shoulder girdle neuritis, shoulder girdle syndrome

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Contributor Information and Disclosures

Author

Nigel L Ashworth, MBChB, MSc, FRCPC, Professor and Chief, Division of Physical Medicine and Rehabilitation, Glenrose Rehabilitation Hospital, University of Alberta
Nigel L Ashworth, MBChB, MSc, FRCPC is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, Australian & New Zealand Association of Neurologists, British Medical Association, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, Canadian Society of Clinical Neurophysiologists, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Benjamin M Sucher, DO, FAAPMR, FAOCPMR, Medical Director, EMG Labs of AARA (Arizona Arthritis & Rheumatology Associates)
Benjamin M Sucher, DO, FAAPMR, FAOCPMR is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Osteopathic Association, and American Osteopathic College of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier III, MD, Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke's Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital
Robert H Meier III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

 
 
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