Brachial Neuritis (Parsonage-Turner Syndrome)

By: Peter F. Ullrich, Jr., MD Brachial neuritis is a term used to describe an inflammation of the brachial plexus that causes sudden-onset shoulder and arm pain, followed by weakness and/or numbness. After the nerve roots leave the cervical spine (in the neck), they combine to form the brachial plexus. The brachial plexus is a network of nerves that runs through the shoulder and down the arm. Inflammation of this network of sensitive nerves can cause sudden, severe pain. The condition is known by a variety of names, including: Parsonage-Turner Syndrome Brachial Plexitis Brachial Plexopathy Brachial Plexus Injury Brachial Neuropathy Acute Brachial Radiculitis Parsonage-Aldren-Turner Syndrome Brachial Plexus Neuropathy On Spine-health.com, this condition is termed brachial neuritis. This condition is relatively rare. The exact cause is unknown, and the condition is relatively poorly understood. This article reviews what is known about the symptoms, diagnosis and recovery process for brachial neuritis.

Brachial Neuritis Symptoms

The pain usually starts in the shoulder and/or upper arm. Usually the pain is sudden and severe, and characterized by one or more of the following: Sudden onset of pain (usually not related to an injury) Pain that begins in the shoulder and/or upper arm Pain is described as piercing, sharp, or radiating, as opposed to a dull ache or throbbing pain Symptoms are experienced only on one side of the body, not in both arms at once Severe pain typically lasts for several days, after which the arm becomes weak in multiple different muscles. The arm weakness may be profound, but will usually get better with time. In rare, severe cases, partial or complete arm paralysis may result. For most people, the weakness and numbness will get better within a few months or up to a year.

Diagnosis
Diagnosis is arrived at after a thorough patient history and physical examination. Imaging studies of the cervical spine (such as an X-ray or MRI scan) will usually not show anything. If there is any question that the pain is from a cervical radiculopathy (a pinched nerve root) versus a brachial plexus inflammation, an EMG study can help differentiate the two conditions. One of the most important considerations of this diagnosis is recognition. Pain that is severe and brief (less than 7 to 10 days), and is associated with severe weakness, is indicative of brachial neuritis.

A compressive lesion, such as a cervical herniated disc, needs to be ruled out by an MRI scan early on to make sure that there is nothing correctible. After 3 weeks, an EMG study can be done to confirm the diagnosis. An accurate diagnosis of the cause of the patients symptoms is imperative. A serious risk in this situation is to confuse the symptoms with a compressive lesion, such as a cervical herniated disc, and do an unnecessary surgery.

Depending on the severity of the individuals symptoms, treatment for brachial neuritis will often be two-fold: 1) an initial focus on controlling the pain, and; 2) a longer term focus on nerve healing and rehabilitation.

Treatment for Acute Brachial Pain

In the initial phase, the inflamed brachial nerves can be severely painful. The initial course of treatment is typically focused on reducing the patients pain: Oral steroids to reduce the inflammation (which is usually a component of the pain) Rest or reduced activity Narcotic medications for several days if they are needed to help control severe pain Neurotropic medications (such as Lyrica or Neurontin) should be started early in the course of the symptoms, as these medications can help stabilize nerve membranes and control pain.

Treatment for Longer Term Brachial Nerve Healing

Once the severe pain has subsided, the patient will need time and patience for healing, and may need physical therapy for maximum recovery. The most important factor for the patients recovery is time. The damage to the brachial plexus is done early, and takes time to resolve. Surgery is never an option as the nerve damage is most likely due to an infectious etiology (cause) and not a compressive lesion (such as a pinched nerve in the neck). The patient may need physical therapy and rehabilitation to recover maximum use of the arm. The physical therapy may focus on restoring range of motion in the arm, arm and shoulder strength, and rebuilding normal function. It is important to note that the symptoms of arm pain and numbness from brachial neuritis can be similar to other conditions, such as symptoms of a cervical disc herniation. Therefore, a critical factor in successful treatment for this condition is first obtaining an accurate diagnosis. A serious potential risk in this situation is to confuse the symptoms of brachial neuritis with a cervical herniated disc or other type of nerve compression and have an unnecessary surgery, rather than the appropriate course of rest, medications and physical therapy.