eMedicine Specialties > Physical Medicine and Rehabilitation > Peripheral Neuropathy

Brachial Neuritis: Follow-up

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

Follow-up

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.

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.

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%.24

Miscellaneous

Medicolegal Pitfalls

 


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

  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. 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].

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

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  13. 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].

  14. 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].

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

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

  17. 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].

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

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

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

  21. 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].

  22. 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].

  23. 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].

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

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

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

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

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

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

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

  31. 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].

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

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

  34. 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].

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

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

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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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