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Brachial plexus neuropathy

Overview

Brachial plexus neuropathy (BPN) occurs when nerves in your upper shoulder area become damaged. This can cause severe pain in your shoulders or arms. BPN may also limit movement and cause decreased sensation in these areas.

The pain associated with BPN generally occurs suddenly and may be followed by weakness in a specific muscle of the arm or shoulder. BPN is an uncommon condition, and its presentation may be misleading. It can sometimes be misdiagnosed as cervical disc herniation.

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Causes

Causes of BPN

BPN is a type of peripheral neuropathy, which refers to damage to a single nerve or a set of nerves. If you have BPN, it’s the brachial plexus that’s damaged. This is an area where nerves from the spinal cord branch into the arm nerves. The nerves of the brachial plexus run from your lower neck through your upper shoulders.

Damage to the brachial plexus usually results from direct injury. Other common causes of damage to the brachial plexus include:

  • birth trauma
  • injury from stretching
  • pressure from tumors
  • damage from radiation therapy

Brachial plexus neuropathy may also be associated with:

  • birth defects
  • exposure to toxins
  • inflammatory conditions
  • immune system issues

There are, however, numerous cases of brachial plexus neuropathy in which no direct cause can be identified.

Risk factors

BPN risk factors

There are no specific risk factors associated with BPN. However, young men are more likely than women and older men to develop a rare brachial plexus condition known as Parsonage-Turner syndrome. This condition can cause shoulder paralysis.

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Symptoms

Symptoms of BPN

Numbness

BPN can cause numbness in your shoulder, arm, and hand. Severe cases can cause a complete loss of sensation. This numbness can cause additional complications related to recurring injury to the affected areas. You won’t notice these complications if you have an inability to detect pain in those areas.

Abnormal sensations

Sometimes BPN can cause abnormal sensations such as tingling and burning on or near nerves related to the brachial plexus. These types of sensations generally occur in your arm and hand.

Weakness

A decreased ability to lift your wrist or extend it backward is a common way for BPN to manifest. Weakness in your hands may also indicate you have BPN.

Horner syndrome

Horner syndrome is rare, but it can indicate BPN. Horner’s syndrome is caused by an interruption in the nerve signals that control parts of the face. It’s usually caused by an injury to the nerves of the brachial plexus. The symptoms of Horner’s syndrome include:

  • constriction of the pupil, which makes it very small
  • drooping eyelid
  • an inability to sweat in the affected area of the face

Diagnosing

Diagnosing BPN

Your doctor will examine the following areas to diagnose nerve issues involving the brachial plexus:

  • shoulders
  • arms
  • hands
  • wrists

Some signs of nerve issues may include:

  • arm deformities
  • hand deformities
  • diminished reflexes in the arm
  • muscle wasting, or loss of muscle strength
  • muscle wasting or atrophy (decreased muscle size or strength)
  • an inability to flex the hand and wrist
  • difficulty in moving the arm, shoulder, hand, and fingers

Your doctor will ask you for a detailed medical history to find the cause of your BPN.

He or she may order certain tests to diagnose the condition. These can include:

  • blood tests
  • chest X-rays
  • an electromyogram, which is done to test the function of muscles and related nerves
  • an MRI of the head, shoulder, or neck
  • a nerve biopsy, which involves removing a piece of nerve for analysis
  • nerve conduction tests, which are done to determine how impulses are traveling through a nerve
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Treatment

Treating BPN

BPN treatment is focused on correcting any underlying causes and allowing for optimum range of motion. In many cases, no treatment is needed due to spontaneous recovery.

Taking over-the-counter medications generally controls the pain. Your doctor may also prescribe:

Your doctor might recommend physical therapy to maintain or increases your muscle strength. Orthopedic assistance may also increase range of motion. This type of therapy usually involves using braces, splints, or other similar aids.

You may need surgery if nerve compression is causing your symptoms. Underlying medical conditions such as diabetes and kidney disease may also need to be treated as these diseases can adversely affect nerves.

BPN and the workplace

Sometimes the injury that causes BPN happens while you’re at work. To get back to work and to prevent further nerve damage, your doctor may recommend:

  • vocational counseling
  • occupational therapy
  • retraining
  • vocational changes
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Outlook

BPN outlook

Your outcome largely depends on the cause of your BPN. Recovery is more likely if the cause of your BPN is identified and treated properly.

People with BPN can sometimes have partial or complete loss of sensation, and their range of motion can also be permanently limited. Nerve pain can be severe and last for a long time. Working with your doctor will help ensure you get the proper treatment.

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Prevention

Preventing BPN

Prevention methods vary depending on the cause of your BPN. Once you’ve been diagnosed with BPN and your doctor determines the cause, he or she can provide you with prevention methods.

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