Brachial Neuritis Physiotherapy
Brachial neuritis is a very rare (and specific) inflammation of the group of nerves that control the shoulder, arm, hand and fingers (this nerve group is called brachial plexus).
It is a very frustrating and annoying condition because not only it’s painful and causes weakness, but it’s very hard to diagnose properly. To make it even worse, it comes about very suddenly and quickly without any obvious causes.
Other names of brachial neuritis:
- brachial plexopathy
- Parsonage Turner Syndrome and
- neuralgic amyotrophy
Contents
What is brachial neuritis?
The brachial plexus is a very complex and complicated network of interconnected nerves that start at the neck, and goes downwards, passing the chest over the first rib, through the armpit (also known as the axilla) and then branching downwards into the arm.
This same brachial plexus comprises of lower four cervical nerves (C5-8) and the uppermost thoracic nerve (T1) and it directly controls movement and sensation in the shoulder, arm, hand and fingers.
Nerves send to messages from the brain telling muscles to contract or relax to produce movement as well as carrying sensory information regarding e.g. touch and temperature.
Brachial neuritis causes the brachial plexus to inflame, and this messes with the nerves, decreasing their function and leading to motor and sensory issues including pain and weakness.
2 types of brachial plexopathy
Inherited Brachial Neuritis
Inherited means it’s genetic, and it comes from a familial line from parents or grandparents.
Typically it means there is an aberration or mutation in the SEPT9 chromosomal gene, and it’s autosomal dominant (means that the parent who carries this gene has a 1 in 2 chance of passing this gene to any children they may have).
Idiopathic Brachial Neuritis
Most of patients fall into this category with no known family history of brachial neuritis.
For now, the exact cause is unknown but there is ongoing research which seems to lean towards immune system abnormality, causing it to attack its own nerve fibers.
Causes
The research and medical community isnt clear on what’s the exact-exact cause, but it’s been seen to be associated with
- Infections: Either viral e.g. upper respiratory tract infection or bacterial e.g. pneumonia
- Post-surgery complications
- Traumatic injuries: which can happen anywhere in the body and not necessarily to the shoulder
- Vaccinations: e.g. flu jab and tetanus jabs
- Child birth and delivery
- Systemic Illness e.g. lymphoma and cancer
Overall, it seems linked to an immunity or traumatic medical, orthopedic or surgical event.
Brachial plexopathy is a very, very, very rare condition affecting between 1-3 people per 100,000 individuals per year (that’s a probability of 0.00001% - 0.00003%).
Parsonage Turner Syndrome
Brachial neuritis usually develops quickly and rapidly, and many patients report that their symptoms often starts at night time. Pain tends to be the first symptom which then follows up with weakness and/or paralysis. Common symptoms include:
Pain
A common symptoms of brachial neuritis is sudden, severe pain that can be sharp, stabbing or even hot, burning sensation in the shoulder (which can then travel to the neck, arm, hand and fingers).
It affects the more dominant shoulder, but in some patients, both shoulders can have it at the same time. Usually the pain gets worse with movement / use and when at night.
Weakness
Once the patient’s shoulder pain decreases (with time, some longer some shorter), patients then start to realize or notice that their shoulder is much weaker or difficult to move.
Gradually the affected muscle shrinks (atrophy) and becomes more obviously wasting away, an example is the winging of the scapula (refer to 1st image) – when this happens, it can already be very hard for them to lift or move the affected arm.
The good news is that most of the time, the weakness is temporary.
Numbness
If the sensory nerves of the brachial plexus are affected then it’d affect sensation too, patients may experience
- lack of feeling (like the skin is very thick)
- numbness
- pins and needles
- very sensitive to touch (even light)
Difficulty Breathing
In some rare cases (up to 5%!) the diaphragm can be impacted, leading to
- shortness of breath
- difficulty breathing (inhaling and exhaling)
due to the pain and spasms.
Age Group
Brachial neuritis can affect people at any age (including children which usually indicates the inherited version), but it is more common in younger and middle-aged adults (between 20-55).
Male > female affected
Idiopathic brachial neuritis is 3 times more common in females; whereas in inherited ones it’s 1:1.
Diagnosing brachial neuritis
Brachial neuritis can be tricky, and is often misdiagnosed as
- neck pains
- shoulder pains
- spine
- thoracic outlet syndrome
- etc
Patients will undergo a lot of assessments, sometimes repeatedly, and different imaging solutions such as MRI and xrays (to rule out fractures, dislocations, bursitis and find out specificly what you have). Their shoulder movements, reflexes and sensation will also be assessed as well.
Treatment Options
Pain relief
First of all, we’d need to work with pain, to bring about some form of pain relief – sometimes it’s so painful that we cant just do anything. This can be done with pain medication in the beginning.
Next, shoulder and neck physiotherapy
This is ongoing and should be started as early as tolerable, to improve
- range of motion including stretching, manual therapy and soft tissue management
- gradual strengthening of shoulder and neck
- pain relief using cold pack, heat pack, TENS machine
- acupuncture / dry needling
- etc
Surgery
If the painful symptoms doesnt improve (or worsen) over time, you may have to go for surgery such as nerve graft or nerve blocks to improve movements and decrease pain; so that you can move around as much as you can.
Recovery after brachial neuritis
Good news: most patients can have (nearly) full recovery!
It ranges from patients to patient, but the neurological pain usually settles within a couple of weeks; just that recovery for strength and movement in the shoulder can take much longer (months, at least).
Even better news:
- 80% will fully recover within 2 years
- 90% will fully recover within 3 years
The last 10% may be left with some lingering neurological pains, weaknesses or decreased endurance in the shoulder muscles.
Where To Next?
- Go to Home / Start
- Learn and find out more about your pains (bones, muscles, joints, tendons, ligaments, nerves etc) at Pain Conditions & Injuries
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