Brachial Neuritis

Excerpt

Brachial neuritis, also called neuralgic amyotrophy or Parsonage-Turner syndrome, is a neuromuscular syndrome involving the peripheral nerves. The condition is not well understood and is often underdiagnosed. Though brachial neuritis was previously thought to be an inflammatory process, the underlying etiology remains unclear, with immune-mediated, mechanical, and genetic factors associated with the condition. The primary characteristic symptoms of brachial neuritis are sudden unilateral or bilateral pain in the shoulder girdle, followed by the onset of muscle weakness. Sensory deficits may also be noted in some patients. Typically, the symptoms radiate to the neck, arms, and forearms and may last from a few days to an average of 4 weeks.

Clinicians may have difficulty diagnosing brachial neuritis due to the condition's multifocal symptoms, various presentations, and the delayed manifestation of pathophysiologic changes on testing. To avoid misdiagnosis, clinicians must be familiar with the clinical course of brachial neuritis and be able to differentiate it from similar conditions, as an inaccurate diagnosis can lead to unnecessary surgery and increased complications. Brachial neuritis is primarily clinically diagnosed; however, diagnostic studies, including nerve conduction, needle electromyography (EMG), laboratory, and imaging, are typically utilized for diagnostic confirmation. The approach to treatment is divided into acute and chronic phases, with therapies varying depending on the progression of symptoms. However, management often includes supportive therapies, physical therapy, corticosteroids, and intravenous immunoglobulin. In some patients, surgical procedures such as neurolysis may be considered. This activity for healthcare professionals aims to enhance learners' competence in recognizing brachial neuritis, excluding differential diagnoses, selecting appropriate diagnostic tests, managing the acute and chronic phases of the condition, and fostering effective interprofessional teamwork to improve outcomes.