From the Guidelines
Brachial plexus neuropathy, also known as Parsonage-Turner syndrome or neuralgic amyotrophy, is a painful condition that should be treated with a multidisciplinary approach, including pain management, physical therapy, and potentially corticosteroids, as supported by the most recent guidelines from the American College of Radiology 1. The condition affects the nerves that control the shoulder, arm, and hand, and its treatment typically begins with pain management using NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), combined with stronger analgesics such as gabapentin (starting at 300mg daily and titrating up to 1800-3600mg daily in divided doses) or pregabalin (starting at 75mg twice daily, up to 300mg daily) for neuropathic pain 1, 2. Some key points to consider in the management of brachial plexus neuropathy include:
- Physical therapy should be initiated early to maintain range of motion and prevent contractures, with sessions 2-3 times weekly for several months 3.
- Corticosteroids like prednisone (60mg daily with taper over 2-3 weeks) may help reduce inflammation in the acute phase if started within the first few weeks 4.
- The condition results from immune-mediated inflammation of the brachial plexus nerves, often triggered by infections, vaccinations, surgery, or strenuous exercise, leading to demyelination and axonal damage that causes the characteristic severe pain followed by weakness and muscle atrophy 1, 5. It is essential to note that the diagnosis of brachial plexus neuropathy is typically based on clinical and electrodiagnostic evaluation, and imaging studies such as MRI may be useful in detecting nerve abnormalities and/or neuromuscular variants associated with extraspinal nerve compression 2, 5.
From the Research
Brachial Plexus Neuropathy
- Brachial plexus neuropathy is a condition that can result from traumatic injury, often requiring specialized treatment and a prolonged rehabilitation period 6.
- The incidence of neuropathic pain after brachial plexus injury is high, reaching up to 95% of cases, especially if cervical root avulsion has occurred 7.
- Managing neuropathic pain after brachial plexus injury is complex and must be accomplished by a multidisciplinary team, starting with first-line pharmacological therapies like tricyclic antidepressants and calcium channel ligands, combined physical and occupational therapy, transcutaneous electrical stimulation and psychological support 7.
Treatment Options
- Physical therapy modalities, including kinesiotherapy, electrothermal and phototherapy, manual therapy, and sensory re-education strategies, are commonly used in the treatment of brachial plexus injury 6.
- Oral pregabalin has been shown to prolong analgesia from brachial plexus block without significant effect on the motor block, and premedication with oral pregabalin increases the sensory block of brachial plexus block 8.
- Neurolysis and oral gabapentin can be effective in managing neuropathic pain following traumatic brachial plexus injury 9.
- Surgical reconstruction, including neurolysis, nerve grafting, nerve transfers, free functional muscle transfers, tendon transfers, and joint arthrodesis, can provide patients with meaningful recovery 10.
Multidisciplinary Approach
- The successful management of patients with brachial plexus injury requires a multidisciplinary team approach, including peripheral nerve surgeons, neurology, hand therapy, physical therapy, pain management, social work, and mental health 10.
- A multidisciplinary team approach can provide patients with comprehensive care, open and practical discussions about realistic expectations, and thoughtful reconstructive planning 10.