Diagnostic Considerations

Table. Other Problems to Consider in Radiation-Induced Brachial Plexopathy Diagnosis (Open Table in a new window)

Feature	Tumor Infiltration	Radiation Fibrosis	Transient Radiation Injury	Acute Ischemic Injury
Incidence of pain	80%	18%	40%	Painless
Location of pain	Shoulder, upper arm, elbow, fourth and fifth fingers	Shoulder, wrist, hand	Hand, forearm	Hand, forearm
Nature of pain	Dull ache in shoulder, lancinating pains in elbow and ulnar aspect of hand; occasional paresthesias and dysesthesias	Ache in shoulder; prominent paresthesias in C-5/C-6 distribution of hand and arm	Ache in shoulder; prominent paresthesias in C-5/C-6 distribution of hand and arm	Paresthesias in C-5/C-6 distribution of hand and arm
Severity	Moderate to severe (severe in 98%)	Usually mild to moderate (severe in 20-35%)	Mild	Mild
Course	Progressive neurologic dysfunction; atrophy and weakness in C-7/T-1 distribution, persistent pain; occasional Horner syndrome	Progressive weakness; panplexus or upper plexus distribution; Horner syndrome uncommon	Translate weakness with complete resolution	Acute nonprogressive weakness and sensory loss
Study findings
Magnetic resonance imaging	High signal intensity on T2-weighted images; may enhance with gadolinium	Low signal intensity on T2-weighted images; generally nonenhancing with gadolinium	No data	Normal
Computed tomography	Mass; circumscribed or diffuse tissue infiltration	Diffuse tissue infiltration	Normal	Angiography demonstrates subclavian artery segmental obstruction
Electromyography	Segmental slowing	Diffuse myokymia	Segmental slowing	Segmental slowing

Differential Diagnoses

Workup

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Table. Other Problems to Consider in Radiation-Induced Brachial Plexopathy Diagnosis

Table. Other Problems to Consider in Radiation-Induced Brachial Plexopathy Diagnosis

Feature	Tumor Infiltration	Radiation Fibrosis	Transient Radiation Injury	Acute Ischemic Injury
Incidence of pain	80%	18%	40%	Painless
Location of pain	Shoulder, upper arm, elbow, fourth and fifth fingers	Shoulder, wrist, hand	Hand, forearm	Hand, forearm
Nature of pain	Dull ache in shoulder, lancinating pains in elbow and ulnar aspect of hand; occasional paresthesias and dysesthesias	Ache in shoulder; prominent paresthesias in C-5/C-6 distribution of hand and arm	Ache in shoulder; prominent paresthesias in C-5/C-6 distribution of hand and arm	Paresthesias in C-5/C-6 distribution of hand and arm
Severity	Moderate to severe (severe in 98%)	Usually mild to moderate (severe in 20-35%)	Mild	Mild
Course	Progressive neurologic dysfunction; atrophy and weakness in C-7/T-1 distribution, persistent pain; occasional Horner syndrome	Progressive weakness; panplexus or upper plexus distribution; Horner syndrome uncommon	Translate weakness with complete resolution	Acute nonprogressive weakness and sensory loss
Study findings
Magnetic resonance imaging	High signal intensity on T2-weighted images; may enhance with gadolinium	Low signal intensity on T2-weighted images; generally nonenhancing with gadolinium	No data	Normal
Computed tomography	Mass; circumscribed or diffuse tissue infiltration	Diffuse tissue infiltration	Normal	Angiography demonstrates subclavian artery segmental obstruction
Electromyography	Segmental slowing	Diffuse myokymia	Segmental slowing	Segmental slowing

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Author

Ryan O Stephenson, DO Associate Professor of Clinical Practice, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Medical Director of Polytrauma and Brain Injury (Polytrauma Network Site), Department of Physical Medicine and Rehabilitation, Eastern Colorado Veterans Affairs Medical Center

Ryan O Stephenson, DO 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

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.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Elizabeth A Moberg-Wolff, MD Medical Director, Pediatric Rehabilitation Medicine Associates

Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Merz.

Additional Contributors

Rajesh R Yadav, MD Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas Medical School at Houston

Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Acknowledgements

Robert J Kaplan, MD Staff Physician, Department of Rehabilitation Medicine, James E Van Zandt VA Medical Center

Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.