Radiation-Induced Brachial Plexopathy Treatment & Management

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

Rehabilitation Program

Physical Therapy

Therapeutic modalities should focus on pain reduction, strengthening, preservation of range of motion, and limiting lymphedema. The interventions and modalities should address underlying impairments, as follows:

  • Weakness: Assign therapeutic exercise to enhance flexibility and strength of the shoulder girdle paracervical and parathoracic muscles. The glenohumeral joint may require a sling for sitting or standing activities to reduce the degree of glenohumeral joint subluxation and discomfort.

  • Pain: Use caution when considering the application of heat and cold if the sensation in the extremity is impaired. Transcutaneous electrical nerve stimulation therapy may be considered for pain control.

  • Lymphedema: Educate the patient. Perform manual lymphatic therapy and motorized intermittent pneumatic compression therapy; use graded pressure upper extremity garments.

  • Range of motion: Emphasis should be placed on a home exercise program to preserve range of motion and strength.

Occupational Therapy

Assess basic and instrumental activities of daily living and provide appropriate adaptive equipment.

Provide fine motor skills training, if the lower plexus is involved.

Recommend sensory and motor re-education techniques.

Consider using a flexor hinge tenodesis orthosis with or without long opponens orthosis if it allows the patient to be functionally prehensile.

Recreational Therapy

Focus on enjoyable activities that help to preserve range of motion and retain or build strength while limiting pain and discomfort.

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Medical Issues/Complications

As with other conditions that produce lymphedema of the upper extremity, hygiene plays an important role in radiation-induced brachial plexopathy, and venipuncture should be avoided to obviate the risk of cellulitis/lymphangitis.

If the affected extremity is involved in trauma with skin laceration, exercise vigilance in monitoring for cellulitis or lymphangitis. Antibiotic treatment should be considered early if there is any indication of infection.

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Surgical Intervention

Glenohumeral joint arthrodesis rarely is indicated.

Lymphatic bypass surgery interventions to divert or to redirect lymphatic flow rarely are required.

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Consultations

A radiation oncologist, neuro-oncologist, neuroradiologist, and physical medicine/rehabilitation specialist can assist in diagnosis and management.

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Other Treatment

Dorsal root entry zone lesion or chemical sympathectomy can be considered for intractable cases of chronic severe pain.

Neurolysis/decompression of the first rib or clavicle and neural grafting generally are not indicated.

Hyperbaric oxygen has not shown reproducible neurologic benefit.

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