Brachial Neuritis Treatment & Management
- Author: Nigel L Ashworth, MBChB, MSc, FRCPC; Chief Editor: Milton J Klein, DO, MBA more...
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. 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.
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.
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. 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.
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.
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