Radiation-Induced Brachial Plexopathy Follow-up

Updated: Apr 02, 2019
  • Author: Ryan O Stephenson, DO; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Follow-up

Further Outpatient Care

Continue to monitor the neurologic examination findings and clinical symptomatology. If unexpected changes occur, consider repeating electromyography or MRI.

Reinforce patient education regarding protection and care of the extremity with lymphedema. If lymphedema worsens, consider the aforementioned therapeutic interventions and perform an MRI to rule out metastatic disease.

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Inpatient & Outpatient Medications

For pain control, tricyclic antidepressants, anticonvulsants, or serotonin–norepinephrine reuptake inhibitors may be indicated for lancinating/neuropathic-type pain. Traditional analgesics also play a role in the treatment of neuropathic pain.

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Transfer

If there is evidence of neoplastic disease, the patient needs to be reevaluated by oncological services.

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Deterrence

Use focally directed radiotherapy with doses below 55 Gy. A study by Chen et al indicated that in patients undergoing radiotherapy for head-and-neck cancer, a significant association exists between radiation dosages of more than 70 Gy over more than 10% of the brachial plexus volume and the development of brachial plexopathy symptoms. The study involved 352 disease-free patients who had finished radiotherapy for squamous cell carcinoma of the head and neck a median of 40 months prior to the study. [24]

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Complications

Complications may include the following:

  • Lymphangitis

  • Cellulitis

  • Complex regional pain syndrome, type 2

  • Glenohumeral joint subluxation

  • Contractures in the involved upper extremity

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Prognosis

One third of patients experience significant progression of their radiation-induced plexopathy, whereas the remainder of patients demonstrate gradual progression. Rarely, a mild form of reversible radiation plexopathy may present.

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Patient Education

Patients should be educated about the expected progressive course of radiation plexopathy. A home exercise program should be considered to preserve strength and range of motion. Susceptibility to trauma and infection due to altered sensation, edema, and fibrotic tissue should be discussed.

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