Brachial Neuritis Follow-up

  • Author: Nigel L Ashworth, MBChB, MSc, FRCPC; Chief Editor: Robert H Meier III, MD   more...
 
Updated: Jan 18, 2012
 

Further Outpatient Care

  • The treatment of brachial neuritis (BN) usually is completed conservatively on an outpatient basis. Surgical intervention is indicated for patients who do not demonstrate good recovery after 2 years of conservative care. Please refer to the Rehabilitation Program section for a discussion of outpatient rehabilitation and treatment options for individuals with BN.
Next

Complications

  • Shoulder joint contractures (and potentially others) can occur.
  • Sudden, severe dyspnea due to phrenic nerve involvement may be noted with or without other symptoms of brachial neuritis; however, there should be no other evidence of lung disease.
Previous
Next

Prognosis

  • Eighty percent of patients with brachial neuritis recover functionally within 2 years; 90% recover functionally within 3 years.[4]
  • Bilateral disease has a less favorable outcome than does unilateral disease.
  • Lower trunk lesions have a less favorable prognosis than do upper trunk lesions.
  • The rate of recurrence in the inherited form is approximately 75%. The recurrence in the idiopathic form is thought to be between 5% and 26%.[28]
Previous
 
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 Association of Neuromuscular and Electrodiagnostic Medicine, 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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, 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

Kelly L Allen, MD  Medical Director, Medevals

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.

References

  1. England JD. The variations of neuralgic amyotrophy. Muscle Nerve. Apr 1999;22(4):435-6. [Medline].

  2. England JD, Sumner AJ. Neuralgic amyotrophy: an increasingly diverse entity. Muscle Nerve. Jan 1987;10(1):60-8. [Medline].

  3. Suarez GA, Giannini C, Bosch EP, et al. Immune brachial plexus neuropathy: suggestive evidence for an inflammatory-immune pathogenesis. Neurology. Feb 1996;46(2):559-61. [Medline].

  4. Conway RR. Neuralgic amyotrophy: uncommon but not rare. Mo Med. Mar-Apr 2008;105(2):168-9. [Medline].

  5. Sathasivam S, Lecky B, Manohar R, et al. Neuralgic amyotrophy. J Bone Joint Surg Br. May 2008;90(5):550-3. [Medline].

  6. Pan YW, Wang S, Tian G, Li C, Tian W, Tian M. Typical brachial neuritis (Parsonage-Turner syndrome) with hourglass-like constrictions in the affected nerves. J Hand Surg Am. Jul 2011;36(7):1197-203. [Medline].

  7. Martinoli C, Gandolfo N, Perez MM, Klauser A, Palmieri F, Padua L, et al. Brachial plexus and nerves about the shoulder. Semin Musculoskelet Radiol. Nov 2010;14(5):523-46. [Medline].

  8. Lo YL, Mills KR. Motor root conduction in neuralgic amyotrophy: evidence of proximal conduction block. J Neurol Neurosurg Psychiatry. May 1999;66(5):586-90. [Medline]. [Full Text].

  9. Kuhlenbäumer G, Hannibal MC, Nelis E, et al. Mutations in SEPT9 cause hereditary neuralgic amyotrophy. Nat Genet. Oct 2005;37(10):1044-6. [Medline].

  10. Hoque R, Schwendimann RN, Kelley RE, et al. Painful brachial plexopathies in SEPT9 mutations: adverse outcome related to comorbid states. J Clin Neuromuscul Dis. Jun 2008;9(4):379-84. [Medline].

  11. Laccone F, Hannibal MC, Neesen J, et al. Dysmorphic syndrome of hereditary neuralgic amyotrophy associated with a SEPT9 gene mutation--a family study. Clin Genet. Sep 2008;74(3):279-83. [Medline].

  12. MacDonald BK, Cockerell OC, Sander JW, et al. The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain. Apr 2000;123 ( Pt 4):665-76. [Medline]. [Full Text].

  13. van Alfen N, van der Werf SP, van Engelen BG. Long-term pain, fatigue, and impairment in neuralgic amyotrophy. Arch Phys Med Rehabil. Mar 2009;90(3):435-9. [Medline].

  14. Stogbauer F, Young P, Kuhlenbaumer G, et al. Hereditary recurrent focal neuropathies: clinical and molecular features. Neurology. Feb 8 2000;54(3):546-51. [Medline].

  15. Park P, Lewandrowski KU, Ramnath S, et al. Brachial neuritis: an under-recognized cause of upper extremity paresis after cervical decompression surgery. Spine. Oct 15 2007;32(22):E640-4. [Medline].

  16. Kumar N, Folger WN, Bolton CF. Dyspnea as the predominant manifestation of bilateral phrenic neuropathy. Mayo Clin Proc. Dec 2004;79(12):1563-5. [Medline].

  17. Lahrmann H, Grisold W, Authier FJ, et al. Neuralgic amyotrophy with phrenic nerve involvement. Muscle Nerve. Apr 1999;22(4):437-42. [Medline].

  18. Tsao BE, Ostrovskiy DA, Wilbourn AJ, et al. Phrenic neuropathy due to neuralgic amyotrophy. Neurology. May 23 2006;66(10):1582-4. [Medline].

  19. Pierre PA, Laterre CE, Van den Bergh PY. Neuralgic amyotrophy with involvement of cranial nerves IX, X, XI and XII [published erratum appears in Muscle Nerve 1991 Jan;14(1):88]. Muscle Nerve. Aug 1990;13(8):704-7. [Medline].

  20. Gazioglu S, Boz C, Sari A. Magnetic resonance imaging in bilateral brachial neuritis with pure sensory involvement. Neurol Sci. Nov 24 2011;[Medline].

  21. Vassallo G, Martland T, Forbes W, McCullagh G. A valuable non-invasive diagnostic investigation for paediatric idiopathic brachial neuritis. Dev Med Child Neurol. Oct 2010;52(10):966-8. [Medline].

  22. Flaggman PD, Kelly JJ Jr. Brachial plexus neuropathy. An electrophysiologic evaluation. Arch Neurol. Mar 1980;37(3):160-4. [Medline].

  23. Martin WA, Kraft GH. Shoulder girdle neuritis: a clinical and electrophysiological evaluation. Mil Med. Jan 1974;139(1):21-5. [Medline].

  24. McCarty EC, Tsairis P, Warren RF. Brachial neuritis. Clin Orthop Relat Res. Nov 1999;37-43. [Medline].

  25. van Alfen N, Huisman WJ, Overeem S, et al. Sensory nerve conduction studies in neuralgic amyotrophy. Am J Phys Med Rehabil. Apr 28 2009;[Medline].

  26. van Alfen N, van Engelen BG, Hughes RA. Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis). Cochrane Database Syst Rev. Jul 8 2009;CD006976. [Medline].

  27. van Eijk JJ, van Alfen N, Berrevoets M, et al. Evaluation of prednisone treatment in the acute phase of neuralgic amyotrophy: an observational study. J Neurol Neurosurg Psychiatry. Mar 24 2009;[Medline].

  28. van Alfen N, van Engelen BG. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain. Feb 2006;129:438-50. [Medline]. [Full Text].

  29. Aymond JK, Goldner JL, Hardaker WT Jr. Neuralgic amyotrophy. Orthop Rev. Dec 1989;18(12):1275-9. [Medline].

  30. Dumitru D. Brachial plexopathies and proximal mononeuropathies. In: Dumitru D, ed. Electrodiagnostic Medicine. Philadelphia, Pa: Hanley & Belfus; 1994:585-642.

  31. Magee KR, Dejong RN. Paralytic brachial neuritis. Discussion of clinical features with review of 23 cases. JAMA. Nov 5 1960;174:1258-62. [Medline].

  32. Misamore GW, Lehman DE. Parsonage-Turner syndrome (acute brachial neuritis). J Bone Joint Surg Am. Sep 1996;78(9):1405-8. [Medline].

  33. Parsonage MJ, Turner JW. Neuralgic amyotrophy; the shoulder-girdle syndrome. Lancet. Jun 26 1948;1(26):973-8. [Medline].

  34. Subramony SH. AAEE case report #14: neuralgic amyotrophy (acute brachial neuropathy). Muscle Nerve. Jan 1988;11(1):39-44. [Medline].

  35. Tsairis P, Dyck PJ, Mulder DW. Natural history of brachial plexus neuropathy. Report on 99 patients. Arch Neurol. Aug 1972;27(2):109-17. [Medline].

  36. Turner JW, Parsonage MJ. Neuralgic amyotrophy (paralytic brachial neuritis); with special reference to prognosis. Lancet. Aug 3 1957;273(6988):209-12. [Medline].

  37. van Alfen N. The neuralgic amyotrophy consultation. J Neurol. Jun 2007;254(6):695-704. [Medline].

  38. Walker M, Zunt JR, Kraft GH. Brachial neuropathy after immunosuppression and stem cell transplantation for multiple sclerosis. Mult Scler. Feb 2005;11(1):90-1. [Medline].

  39. Weikers NJ, Mattson RH. Acute paralytic brachial neuritis. A clinical and electrodiagnostic study. Neurology. Dec 1969;19(12):1153-8. [Medline].

  40. Wilbourn AJ. Brachial plexus disorders. In: Dyck PJ, Thomas PK, eds. Peripheral Neuropathy. Philadelphia, Pa: WB Saunders; 1993:911-50.

 
Previous
Next
 
The patient is a 43-year-old farmer, shown 6 months after presenting with severe right shoulder pain and weakness. Note severe wasting of the right infraspinatus and deltoid and winging of the scapula.
Same patient as above. Note again severe supraspinatus and infraspinatus wasting on the right.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.