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.^[7]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.^{[44, 45]}

However, a study by van Eijk et al indicates that oral prednisolone, a corticosteroid, may be an effective pain treatment for BN.^[46]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

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.

Medication

Al Khalili Y, Jain S, DeCastro A. Brachial Neuritis. StatPearls. 2020 Jan. [QxMD MEDLINE Link]. [Full Text].
Sneag DB, Rancy SK, Wolfe SW, et al. Brachial plexitis or neuritis? MRI features of lesion distribution in Parsonage-Turner syndrome. Muscle Nerve. 2018 Sep. 58 (3):359-66. [QxMD MEDLINE Link].
Ferrante MA, Wilbourn AJ. Lesion distribution among 281 patients with sporadic neuralgic amyotrophy. Muscle Nerve. 2017 Jun. 55 (6):858-61. [QxMD MEDLINE Link].
England JD. The variations of neuralgic amyotrophy. Muscle Nerve. 1999 Apr. 22(4):435-6. [QxMD MEDLINE Link].
England JD, Sumner AJ. Neuralgic amyotrophy: an increasingly diverse entity. Muscle Nerve. 1987 Jan. 10(1):60-8. [QxMD MEDLINE Link].
Ortiz Torres M, Mesfin FB. Brachial Plexitis (Parsonage Turner Syndrome, Brachial Neuropathy, Brachial Radiculitis). 2018 Jan. [QxMD MEDLINE Link]. [Full Text].
McCarty EC, Tsairis P, Warren RF. Brachial neuritis. Clin Orthop Relat Res. 1999 Nov. 37-43. [QxMD MEDLINE Link].
Park P, Lewandrowski KU, Ramnath S, et al. Brachial neuritis: an under-recognized cause of upper extremity paresis after cervical decompression surgery. Spine. 2007 Oct 15. 32(22):E640-4. [QxMD MEDLINE Link].
Gazioglu S, Boz C, Sari A. Magnetic resonance imaging in bilateral brachial neuritis with pure sensory involvement. Neurol Sci. 2011 Nov 24. [QxMD MEDLINE Link].
Vassallo G, Martland T, Forbes W, McCullagh G. A valuable non-invasive diagnostic investigation for paediatric idiopathic brachial neuritis. Dev Med Child Neurol. 2010 Oct. 52(10):966-8. [QxMD MEDLINE Link].
Suarez GA, Giannini C, Bosch EP, et al. Immune brachial plexus neuropathy: suggestive evidence for an inflammatory-immune pathogenesis. Neurology. 1996 Feb. 46(2):559-61. [QxMD MEDLINE Link].
Conway RR. Neuralgic amyotrophy: uncommon but not rare. Mo Med. 2008 Mar-Apr. 105(2):168-9. [QxMD MEDLINE Link].
Sathasivam S, Lecky B, Manohar R, et al. Neuralgic amyotrophy. J Bone Joint Surg Br. 2008 May. 90(5):550-3. [QxMD MEDLINE Link].
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. 2011 Jul. 36(7):1197-203. [QxMD MEDLINE Link].
Martinoli C, Gandolfo N, Perez MM, Klauser A, Palmieri F, Padua L, et al. Brachial plexus and nerves about the shoulder. Semin Musculoskelet Radiol. 2010 Nov. 14(5):523-46. [QxMD MEDLINE Link].
Lo YL, Mills KR. Motor root conduction in neuralgic amyotrophy: evidence of proximal conduction block. J Neurol Neurosurg Psychiatry. 1999 May. 66(5):586-90. [QxMD MEDLINE Link]. [Full Text].
Kuhlenbäumer G, Hannibal MC, Nelis E, et al. Mutations in SEPT9 cause hereditary neuralgic amyotrophy. Nat Genet. 2005 Oct. 37(10):1044-6. [QxMD MEDLINE Link].
Hoque R, Schwendimann RN, Kelley RE, et al. Painful brachial plexopathies in SEPT9 mutations: adverse outcome related to comorbid states. J Clin Neuromuscul Dis. 2008 Jun. 9(4):379-84. [QxMD MEDLINE Link].
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. 2008 Sep. 74(3):279-83. [QxMD MEDLINE Link].
Aranyi Z, Csillik A, Devay K, et al. Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement and torsion. Muscle Nerve. 2015 Feb 20. [QxMD MEDLINE Link].
Sneag DB, Rancy SK, Wolfe SW, et al. Brachial plexitis or neuritis? MRI features of lesion distribution in Parsonage-Turner syndrome. Muscle Nerve. 2018 Feb 20. [QxMD MEDLINE Link].
Ferrante MA, Wilbourn AJ. The Lesion Distribution among 281 Patients with Sporadic Neuralgic Amyotrophy. Muscle Nerve. 2016 Sep 28. [QxMD MEDLINE Link].
Lustenhouwer R, Cameron IGM, van Alfen N, et al. Altered sensorimotor representations after recovery from peripheral nerve damage in neuralgic amyotrophy. Cortex. 2020 Feb 28. 127:180-90. [QxMD MEDLINE Link]. [Full Text].
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. 2000 Apr. 123 ( Pt 4):665-76. [QxMD MEDLINE Link]. [Full Text].
van Alfen N, van Eijk JJ, Ennik T, et al. Incidence of neuralgic amyotrophy (Parsonage Turner syndrome) in a primary care setting - a prospective cohort study. PLoS One. 2015. 10 (5):e0128361. [QxMD MEDLINE Link].
McEnery T, Walsh R, Burke C, McGowan A, Faul J, Cormican L. Phrenic Nerve Palsy Secondary to Parsonage-Turner Syndrome: A Diagnosis Commonly Overlooked. Lung. 2017 Apr. 195 (2):173-7. [QxMD MEDLINE Link].
van Alfen N, van der Werf SP, van Engelen BG. Long-term pain, fatigue, and impairment in neuralgic amyotrophy. Arch Phys Med Rehabil. 2009 Mar. 90(3):435-9. [QxMD MEDLINE Link].
Cup EH, Ijspeert J, Janssen RJ, Bussemaker-Beumer C, Jacobs J, Pieterse AJ, et al. Residual complaints after neuralgic amyotrophy. Arch Phys Med Rehabil. 2013 Jan. 94(1):67-73. [QxMD MEDLINE Link].
Stogbauer F, Young P, Kuhlenbaumer G, et al. Hereditary recurrent focal neuropathies: clinical and molecular features. Neurology. 2000 Feb 8. 54(3):546-51. [QxMD MEDLINE Link].
Kumar N, Folger WN, Bolton CF. Dyspnea as the predominant manifestation of bilateral phrenic neuropathy. Mayo Clin Proc. 2004 Dec. 79(12):1563-5. [QxMD MEDLINE Link].
Lahrmann H, Grisold W, Authier FJ, et al. Neuralgic amyotrophy with phrenic nerve involvement. Muscle Nerve. 1999 Apr. 22(4):437-42. [QxMD MEDLINE Link].
Tsao BE, Ostrovskiy DA, Wilbourn AJ, et al. Phrenic neuropathy due to neuralgic amyotrophy. Neurology. 2006 May 23. 66(10):1582-4. [QxMD MEDLINE Link].
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. 1990 Aug. 13(8):704-7. [QxMD MEDLINE Link].
van Eijk JJ, Madden RG, van der Eijk AA, et al. Neuralgic amyotrophy and hepatitis E virus infection. Neurology. 2014 Feb 11. 82(6):498-503. [QxMD MEDLINE Link]. [Full Text].
Bazerbachi F, Haffar S, Garg SK, Lake JR. Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature. Gastroenterol Rep (Oxf). 2016 Feb. 4 (1):1-15. [QxMD MEDLINE Link]. [Full Text].
Ripellino P, Pasi E, Melli G, et al. Neurologic complications of acute hepatitis E virus infection. Neurol Neuroimmunol Neuroinflamm. 2020 Jan. 7 (1):[QxMD MEDLINE Link]. [Full Text].
Lecrubier A. New Safety Data Regarding COVID Vaccines. Medscape Medical News. 2021 Oct 14. [Full Text].
Zara G, Gasparotti R, Manara R. MR imaging of peripheral nervous system involvement: Parsonage-Turner syndrome. J Neurol Sci. 2012 Apr 15. 315(1-2):170-1. [QxMD MEDLINE Link].
Sneag DB, Saltzman EB, Meister DW, Feinberg JH, Lee SK, Wolfe SW. MRI bullseye sign: An indicator of peripheral nerve constriction in Parsonage-Turner syndrome. Muscle Nerve. 2017 Jul. 56 (1):99-106. [QxMD MEDLINE Link].
Lieba-Samal D, Jengojan S, Kasprian G, Wober C, Bodner G. Neuroimaging of classic neuralgic amyotrophy. Muscle Nerve. 2016 Apr 13. [QxMD MEDLINE Link].
Flaggman PD, Kelly JJ Jr. Brachial plexus neuropathy. An electrophysiologic evaluation. Arch Neurol. 1980 Mar. 37(3):160-4. [QxMD MEDLINE Link].
Martin WA, Kraft GH. Shoulder girdle neuritis: a clinical and electrophysiological evaluation. Mil Med. 1974 Jan. 139(1):21-5. [QxMD MEDLINE Link].
van Alfen N, Huisman WJ, Overeem S, et al. Sensory nerve conduction studies in neuralgic amyotrophy. Am J Phys Med Rehabil. 2009 Apr 28. [QxMD MEDLINE Link].
van Alfen N, van Engelen BG, Hughes RA. Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis). Cochrane Database Syst Rev. 2009 Jul 8. CD006976. [QxMD MEDLINE Link].
Naito KS, Fukushima K, Suzuki S, Kuwahara M, Morita H, Kusunoki S, et al. Intravenous immunoglobulin (IVIg) with methylprednisolone pulse therapy for motor impairment of neuralgic amyotrophy: clinical observations in 10 cases. Intern Med. 2012. 51(12):1493-500. [QxMD MEDLINE Link].
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. 2009 Mar 24. [QxMD MEDLINE Link].
Feinberg JH, Nguyen ET, Boachie-Adjei K, et al. The electrodiagnostic natural history of Parsonage-Turner syndrome. Muscle Nerve. 2017 Oct. 56 (4):737-43. [QxMD MEDLINE Link].
van Alfen N, van Engelen BG. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain. 2006 Feb. 129:438-50. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

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.