Brachial Plexopathy

Anatomy

Brachial plexopathy is a form of peripheral neuropathy, a dysfunction that involves the brachial plexus.  The brachial plexus is a network of nerves located deep to the neck and shoulder formed by nerve roots that exit the spinal cord, merge together and leave as individual nerves that supply the upper extremities.

The Problem

 Brachial plexopathy occurs when then nerve structures of the brachial plexus are not functioning properly.  This can result in a variety of symptoms, ranging from pain, weakness, decreased sensation or painful numbness in the shoulder, arm or hand.  The brachial plexus is a very complex structure.  The area of the plexus that is damaged determines the symptoms that will result.

Causes

The brachial plexus can be injured by direct trauma or stretch, including birth trauma.  Tumors or radiation can also damage the plexus.  Disease can cause the problem, most commonly an autoimmune disorder, known as brachial neuritis.  This can result in painful burning in the shoulder that gradually improves over time.

Diagnosis

Detailed history may suggest the cause of the problem.  Physical examination can demonstrates the muscles and nerves that are affected which, in turn, helps to determine the area or areas of the plexus that have been affected.

Because the structure of the brachial plexus is complex, it can be difficult to pinpoint the area of the injury.  Nerve conduction studies (NCS) and EMG assess the function of the multiple nerve structures that make up the plexus.  This can reveal the location of injury, the nature of the injury, its severity and prognosis.  Imaging studies, including MRI, are sometimes used to diagnose the problem.

Treatment

Treatment is directed towards symptom relief, restoration and recovery of upper extremity function.  Where possible, it is focused on correction of underlying causes.  A variety of pain medications can be helpful in relieving pain.  Splints can be prescribed to compensate for weakness and to aid upper extremity function.  Some patients with brachial plexopathy can benefit from surgery when the underlying problem is nerve compression.  Nerve grafts and nerve, tendon or muscle transfers can be performed at surgical specialty centers to help restore lost upper extremity function.