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Brachial Neuritis Treatment & Management

  • Author: Nigel L Ashworth, MBChB, MSc, FRCPC; Chief Editor: Milton J Klein, DO, MBA  more...
Updated: May 08, 2016

Rehabilitation Program

Physical Therapy

Physical therapy for patients with brachial neuritis should be focused on the maintenance of full range of motion (ROM) in the shoulder and other affected joints.[31] Passive ROM (PROM) and active ROM (AROM) exercises should begin as soon as the patient's pain has been adequately controlled; these should be followed by regional conditioning of the affected areas. Strengthening of the rotator cuff muscles and scapular stabilization may be indicated. Passive modalities (eg, heat, cold, transcutaneous electrical nerve stimulation [TENS]) may be useful as adjunct pain relievers.

Occupational Therapy

Functional conditioning of the upper extremity may be helpful in patients with brachial neuritis. Assistive devices and orthotics may be used, depending on the particular disabilities present. The occupational therapist may be involved in maintaining ROM and strengthening, particularly if the hand and wrist are involved.


Medical Issues/Complications

Treatment is largely symptomatic in patients with brachial neuritis (BN), and opiate analgesia often is necessary in the initial period. Immunosuppressive therapy (eg, steroids, immunoglobulin, plasma exchange) is not known to be beneficial for the condition.[33, 34]

However, a study by van Eijk et al indicates that oral prednisolone, a corticosteroid, may be an effective pain treatment for BN.[35] The investigators compared pain relief and strength recovery in 2 groups of patients with BN, one of which (50 patients) received prednisolone during the acute phase of the condition, and the second of which (203 patients) did not receive the drug.

The authors found that the median time required for initial pain relief was 12.5 days in the first group, compared with 20.5 days in the untreated patients. Moreover, 18% of the prednisolone patients recovered strength within the first month of treatment, while only 6.3% of the control group did. In addition, 12% of patients in the prednisolone group attained a full recovery within 1 year, while only 1% of the untreated group fully recovered within that period. The authors recommended that oral prednisolone be used during the acute phase of BN, but they also advised that a prospective, randomized trial be conducted to verify their results.


Surgical Intervention

In brachial neuritis, nerve grafting or tendon transfers may be considered for the few patients who do not achieve good recovery by 2 years. Surgery usually is aimed at improving shoulder abduction.



See the list below:

  • A specialist in neuromuscular disease may be consulted to confirm a diagnosis of brachial neuritis and to evaluate any potentially underlying causes.
  • A specialist in neuromuscular rehabilitation may be asked to provide a comprehensive rehabilitation program for the patient, aimed at maintaining ROM and improving strength and function.
Contributor Information and Disclosures

Nigel L Ashworth, MBChB, MSc, FRCPC Professor, Divisions of Physical Medicine and Rehabilitation and Neurology, University of Alberta Faculty of Medicine and Dentistry, Canada

Nigel L Ashworth, MBChB, MSc, FRCPC is a member of the following medical societies: Canadian Society of Clinical Neurophysiologists, Australian & New Zealand Association of Neurologists, American Association of Neuromuscular and Electrodiagnostic Medicine, British Medical Association, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Association of Academic Physiatrists

Disclosure: Received honoraria from Allergan for speaking and teaching.

Chief Editor

Milton J Klein, DO, MBA Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital and Ohio Valley General Hospital

Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Benjamin M Sucher, DO, FAOCPMR, FAAPMR Medical Director, EMG Labs of AARA (Arizona Arthritis and Rheumatology Associates)

Benjamin M Sucher, DO, FAOCPMR, FAAPMR is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic College of Physical Medicine and Rehabilitation, Arizona Society of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Osteopathic Association

Disclosure: Nothing to disclose.

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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.
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