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Disorders
of the brachial or lumbosacral plexus cause a painful mixed sensorimotor
disorder of the corresponding limb.
Because several nerve roots intertwine within the plexus, the symptom pattern does not fit the distribution of individual roots or nerves. Disorders of the rostral brachial plexus affect the shoulders, those of the caudal brachial plexus affect the hands, and those of the lumbosacral plexus affect the legs.
Plexus disorders (plexopathies) are usually due to physical compression or injury. In infants, traction during birth may cause plexopathy. In adults, the cause is usually trauma (typically, for the brachial plexus, a fall that forces the head away from the shoulder) or invasion by metastatic cancer (typically, breast or lung cancer for the brachial plexus and intestinal or GU tumors for the lumbosacral plexus). In patients receiving anticoagulants, a hematoma may compress the lumbosacral plexus. Neurofibromatosis (see Neurologic Disorders in Children: Neurofibromatosis) occasionally involves a plexus. Other causes include postradiation fibrosis (eg, after radiation therapy for breast cancer) and diabetes.
Acute brachial neuritis (neuralgic amyotrophy, Parsonage-Turner syndrome) occurs primarily in men and typically in young adults, although it can occur at any age. Cause is unknown, but viral or immunologic inflammatory processes are suspected.
Symptoms and Signs
Manifestations include extremity pain and motor or sensory deficits that do not correspond to an isolated nerve root or peripheral nerve.
For acute brachial neuritis, symptoms include severe supraclavicular pain, weakness, and diminished reflexes, with minor sensory abnormalities in the distribution of the brachial plexus. Usually, weakness develops and reflexes decrease as pain resolves. Severe weakness develops within 3 to 10 days, then typically regresses over the next few months. The most commonly affected muscles are the serratus anterior (causing winging of the scapula), other muscles innervated by the upper trunk, and muscles innervated by the anterior interosseus nerve (in the forearm—patients may not be able to make an ο with the thumb and index finger).
Diagnosis
Diagnosis is suggested by clinical findings. Electromyography and somatosensory evoked potentials should be done to clarify the anatomic distribution (including possible nerve root involvement). MRI of the appropriate plexus and adjacent spine is indicated for all nontraumatic plexopathies that are not a typical case of brachial neuritis.
Treatment
Treatment is directed at the cause. Corticosteroids, although commonly prescribed, have no proven benefit. Surgery may be indicated for injuries, hematomas, and benign or metastatic tumors. Metastases should also be treated with radiation therapy, chemotherapy, or both. Glycemic control can benefit patients with diabetic plexopathy.
Last full review/revision February 2008 by Michael Rubin, MD
Content last modified February 2008
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