eMedicine Specialties > Physical Medicine and Rehabilitation > Peripheral Neuropathy

Brachial Neuritis: Treatment & Medication

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

Treatment

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.20 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.22

However, a study by van Eijk et al indicates that oral prednisolone, a corticosteroid, may be an effective pain treatment for BN.23 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.

Consultations

  • 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.

Medication

The goal of pharmacotherapy is to reduce morbidity and prevent complications.

Analgesics

These agents often are necessary for initial pain control.20


Acetaminophen (Tylenol, Panadol, Aspirin Free Anacin)

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, who have been diagnosed with upper GI disease, or who are on oral anticoagulants.

Adult

325-650 mg PO q4-6h or 1000 mg tid/qid; not to exceed 4 g/d

Pediatric

<12 years: 10-15 mg/kg/dose PO q4-6h prn; not to exceed 2.6 g/d
>12 years: 325-650 mg PO q4h; not to exceed 5 doses in 24 h

Rifampin can reduce analgesic effects; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Hepatotoxicity can occur in chronic alcoholics with various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness


Acetaminophen and codeine (Tylenol #3)

Indicated for the treatment of mild to moderate pain.

Adult

30-60 mg based on codeine content PO q4-6h or 1-2 tab q4h; not to exceed 12 tab/d

Pediatric

0.5-1 mg/kg based on codeine PO q4-6h; 0-15 mg/kg PO based on acetaminophen content; not to exceed 2.6 g/d of acetaminophen

Toxicity increases with CNS depressants or tricyclic antidepressants

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May result in acute withdrawal symptoms in patients dependent on opiates; caution in severe renal or hepatic dysfunction


Hydrocodone bitartrate and acetaminophen (Vicodin ES)

Drug combination indicated for moderate to severe pain.

Adult

1-2 tab or cap PO q4-6h prn

Pediatric

>12 years: 750 mg acetaminophen PO q4h; not to exceed 10 mg hydrocodone bitartrate per dose or 5 doses/24h
<12 years: 10-15 mg/kg acetaminophen PO q4-6h prn; not to exceed 2.6 g/d acetaminophen

Coadministration with phenothiazines may decrease analgesic effects; toxicity increases with CNS depressants or tricyclic antidepressants

Documented hypersensitivity; elevated intracranial pressure

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Tablets contain metabisulfite, which may cause allergic reactions; caution in severe renal or hepatic dysfunction


Oxycodone and acetaminophen (Percocet)

Drug combination indicated for the relief of moderate to severe pain. DOC for aspirin hypersensitive patients.

Adult

1-2 tab or cap PO q4-6h prn

Pediatric

0.05-0.15 mg/kg oxycodone PO; not to exceed 5 mg/dose of oxycodone q4-6h prn

Phenothiazines may decrease analgesic effects; toxicity increases with coadministration of either CNS depressants or tricyclic antidepressants

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Duration of action may increase in elderly patients; be aware of total daily dose of acetaminophen patient is receiving; do not exceed 4000 mg/24 h of acetaminophen; higher doses may cause liver toxicity

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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