What happens and what forms it comes in
The brachial plexus is formed by roots from the level of the fourth cervical to the first thoracic vertebrae and is divided into trunks and fascicles. The picture depends on which part is damaged. With the upper type, the shoulder muscles suffer: the arm hangs along the body, it is difficult to move it and bend it at the elbow. With the lower type, the hand suffers more, the little finger and ring finger become numb, and small muscles weaken. A total defeat turns off the entire hand. A separate form is neuralgic amyotrophy, in which the plexus becomes inflamed on its own, often after an infection or vaccination.
- Upper type (Erba-Duchenne) - shoulder and forearm
- Lower type (Dejerine-Klumpke) - hand and fingers
- Total plexopathy - whole arm
- Neuralgic amyotrophy - acute inflammatory lesion
- Birth plexopathy in newborns
Causes and risk factors
Mechanical causes predominate: stretching of the plexus when falling on the shoulder, dislocation, fracture of the collarbone, motorcycle injury, prolonged compression by a backpack or uncomfortable position of the hand during anesthesia. Inflammatory forms develop one to two weeks after a viral infection or vaccination. Separately, compression by an additional cervical rib and dense ligaments, as well as tumors and scars after radiation therapy for breast or lung cancer are considered.
- Shoulder and collarbone injuries, dislocations, plexus sprains
- Birth trauma during difficult childbirth
- Infections and vaccination - neuralgic amyotrophy
- Compression by cervical rib, backpack, crutch
- Tumor of the apex of the lung and metastases to the lymph nodes
- Consequences of radiation therapy
- Diabetes mellitus and systemic diseases
Symptoms
Most often, the disease begins with pain - sharp, burning pain in the shoulder and shoulder girdle, worsening at night and difficult to relieve with conventional painkillers. After a few days or weeks, the pain subsides, and weakness comes to the fore: it is difficult to raise an arm, hold a cup, or fasten clothes. Sensitivity throughout the entire arm or part of it is impaired, the muscles gradually lose weight, the shoulder becomes sloping, swelling and discoloration of the skin of the hand may appear.
- Acute pain in the shoulder and upper arm, radiating to the arm
- Arm weakness: difficult to lift, abduct, bend
- Numbness and tingling in the hand and fingers
- Slimming the muscles of the shoulder and scapular region
- Pterygoid scapula with damage to individual nerves
- Dryness or, conversely, sweating of the skin of the hand
- Drooping of the eyelid and constriction of the pupil with the lower type
Diagnostics
The neurologist checks in detail the strength of each muscle group, reflexes and areas of impaired sensitivity - this allows you to determine the level of damage even before the examination. Electroneuromyography shows whether the root, trunk or individual nerve is damaged, and how well the muscles are preserved; Repeat testing after 3–4 weeks helps assess recovery. MRI of the cervical spine and plexus area excludes hernia, root avulsion, tumor and scars. An X-ray or MSCT of the chest is required if there is a suspicion of a process in the apex of the lung.
- Neurological examination with assessment of strength by muscle group
- Electroneuromyography and repeated control
- MRI of the cervical spine
- MRI of the shoulder joint and soft tissues
- X-ray or MSCT of the chest
- Blood test with ESR, C-reactive protein, glucose
Treatment and recovery
Treatment depends on the cause. In the inflammatory form, at the first stage the main thing is to relieve pain: the doctor selects painkillers, sometimes a short course of hormonal drugs. Once the pain goes away, physical therapy plays a key role: passive movements prevent shoulder stiffness from the first days, then add strength exercises. Physiotherapy and massage are used as auxiliary methods. If there is a traumatic rupture or avulsion of the roots, the neurosurgeon may suggest nerve suture, neurolysis, or tendon transfer. Recovery takes from several months to two years, and patience is more important than any drugs.
- Pain relief in the acute phase as prescribed by a doctor
- Early passive exercises for the shoulder joint
- Therapeutic exercise with a gradual increase in load
- Physiotherapy, electrical stimulation, massage courses
- Orthosis or support bandage for severe weakness
- Surgical treatment for traumatic rupture
- Treatment of the underlying disease - tumor, infection, diabetes