Natural History of Brachial Plexus Neuropathy

Tsairis, Peter; Dyck, Peter J.; Mulder, Donald W.

doi:10.1001/archneur.1972.00490140013004

Cited by 520 publications

(429 citation statements)

References 17 publications

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“…Neuralgic amyotrophy (also known as acute brachial plexus neuropathy) is a clinical syndrome characterized by acute-onset pain in the shoulder and arm followed by focal or multifocal weakness with slow recovery over months to years [71][72][73] . Most cases are idiopathic, but an autosomal dominant hereditary form exists, which is usually linked to the SEPT9 gene 74 .…”

Section: Diabetic Lumbosacral Radiculoplexus Neuropathymentioning

confidence: 99%

The nonsystemic vasculitic neuropathies

2017

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The vasculitides are a clinically diverse group of diseases with the histopathological signature of blood vessel-centred inflammation that results in vascular damage and ischaemic injury to the affected tissues 1 . Vasculitis can be caused by drugs, infections and cancers, but diagnostic workup reveals no trigger in most patients. Autoimmune mechanisms are active in all vasculitides, except those caused by direct infection of vessel walls. Most vasculitides are systemic and involve multiple organs and tissues. Those affecting small-to medium-sized vessels often manifest with a vasculitic neuropathy. For example, neuropathies occur in 60-70% of patients with polyarteritis nodosa, eosinophilic granulomatosis with polyangiitis and cryoglobulinaemic vasculitis, and 40-50% of those with microscopic polyangiitis and rheumatoid vasculitis 2 .Vasculitic neuropathy can also occur without systemic vasculitis. This single-organ vasculitis of the PNS has commonly been referred to as nonsystemic vasculitic neuropathy (NSVN), but other forms of clinically isolated PNS vasculitis are now recognized and can be considered variants of NSVN 3 . Although NSVN is classically an acute, relapsing, multifocal neuropathy, it can present as a slowly progressive neuropathy without distinct asymmetries. As such, it should be considered as a possible cause of any progressive axonal neur opathy. NSVN can be diagnosed only with a nerve biopsy, with or without a concomitant muscle or skin biopsy; as nerve biopsies are seldom performed, the condition is under-recognized. The disorder must be distinguished from many other causes of multifocal neuropathy, the definition of which is itself not standardized and requires clarification.A Peripheral Nerve Society guideline group reviewed the literature on vasculitic neuropathy and published consensus recommendations on the classification, diagnosis and immunosuppressive treatment of NSVN in 2010 (REF. 4) Abstract | Nonsystemic vasculitic neuropathy (NSVN) is an under-recognized single-organ vasculitis of peripheral nerves that can only be diagnosed with a nerve biopsy. A Peripheral Nerve Society guideline group published consensus recommendations on the classification, diagnosis and treatment of NSVN in 2010, and new diagnostic criteria for vasculitic neuropathy were developed by the Brighton Collaboration in 2015. In this Review, we provide an update on the classification, diagnosis and treatment of NSVN. NSVN subtypes include Wartenberg migratory sensory neuropathy and postsurgical inflammatory neuropathy. Variants include diabetic radiculoplexus neuropathy and -arguably -neuralgic amyotrophy. NSVN with proximal involvement is sometimes termed nondiabetic lumbosacral radiculoplexus neuropathy. Cutaneous polyarteritis nodosa and other skin-nerve vasculitides overlap with NSVN clinically. Three patterns of involvement in NSVN have been identified: multifocal neuropathy, distal symmetric polyneuropathy, and overlapping multifocal neuropathy (asymmetric polyneuropathy). These patterns lack standard defi...

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Section: Diabetic Lumbosacral Radiculoplexus Neuropathymentioning

confidence: 99%

The nonsystemic vasculitic neuropathies

2017

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“…Some cases of PTS can resolve themselves with recovery of strength and sensation beginning spontaneously as early as 1 month after symptoms onset, with about 75% of complete recovery within 2 years. 18 Therefore, the patient in this case may have improved without treatment or because of other causes. Future studies of chiropractic treatment of patients with PTS should include additional and more rigorous outcome measures.…”

Section: Limitationsmentioning

confidence: 89%

Chiropractic management of a 30-year-old patient with Parsonage-Turner syndrome

Charles

2011

Journal of Chiropractic Medicine

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Objectives: The purpose of this case report is to describe the chiropractic management of a patient presenting with right arm paralysis and a diagnosis of Parsonage-Turner syndrome. Clinical Features: After receiving nerve entrapment release surgery, a 30-year-old man presented with a right arm contracture, atrophy, and weakness with general paralysis of the forearm and index finger of 6 weeks' duration. Intervention and Outcome: The patient was provided chiropractic care that included highvelocity/low-amplitude spinal manipulation based upon applied kinesiology manual muscle testing, soft tissue trigger point therapy, exercises, and stretches. The patient demonstrated improvement in range of motion after the first treatment session. By the eighth treatment, he was able to fully straighten his arm. Three years later, the patient reported that he was able to do mountain climbing and that his arm was fully functional and pain-free. Conclusion: For this patient, chiropractic care seemed to be successful in relieving his right arm paralysis and restoring normal arm movement.

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“…The suprascapular, long thoracic, and axillary nerves are the most commonly involved peripheral nerves [21,27,30,38]. The musculocutaneous, anterior interosseous, ulnar, median, and phrenic nerves were also reported [6,19,23,28].…”

Section: Discussionmentioning

confidence: 99%

Cervical Radiculopathy vs Parsonage–Turner Syndrome: A Case Report

Feinberg

Doward

Gonsalves

2007

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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A 42-year-old recreational cyclist presented with a 3-month history of right-sided neck pain. The patient experienced pain radiating to the right periscapular region and paresthesias in digits 1-3. The onset of the pain was sudden. She described the pain as intermittent and sharp, ranging from 8-10/10 on numeric pain rating scale. The pain was worse at nighttime, often so severe that it would wake her from sleep. She also noted severe headaches and right upper extremity numbness and weakness. She had visited the emergency room twice, both times being admitted to a neurology service because of the severe nature of the pain and what was described as atypical hemiplegia and migraines. A CT scan of the head and cervical spine and an MRI of the cervical spine were normal. The patient was discharged on pain medication, which included prednisone, depakote, zoloft, motrin, and topamax. There was no history of trauma, falls, or any inciting events. She had no history of bowel or bladder incontinence, recent travel, or fever and chills. Her medical history was significant for migraines, right carpal tunnel syndrome, and depression. She was taking lexapro and clonazepam for depression.Physical examination revealed mild limited cervical range of motion with end range axial pain with flexion, extension, and lateral rotation. Spurling maneuver was positive on the right side eliciting pain in digits 1 and 2. Active and passive range of motion of the right shoulder was minimally limited compared to the left (asymptomatic) side. Additional findings included medial winging of the right scapula and mild weakness (4+/5) of the right triceps. Muscle strength throughout the rest of the upper extremities was 5/5. The rest of the physical examination revealed normal muscle bulk and tone, normal sensation, symmetric upper extremity reflexes, and negative Hawkins_, Neer_s, Roos_, Wright_s, and Adson_s provocative tests.Clinical evaluation at this point was suggestive of Parsonage-Turner syndrome vs a cervical radiculopathy, although a broader differential diagnosis was considered (Fig. 1). Electrodiagnostic studies were performed and showed evidence of severe denervation (2+ positive sharp waves and fibs) corresponding to muscles of the right C7 myotome and including the paraspinal muscles, consistent with a right C7 radiculopathy (Fig. 2). Motor unit recruitment was reduced in the involved muscles and there were no polyphasic potentials. An MRI of the cervical spine was repeated and revealed mid to lower cervical spondylosis, moderate left-sided C5/6 foraminal stenosis, and mild right-sided C6/7 foraminal stenosis (Fig. 3). Because the MRI findings did not demonstrate significant nerve root compression, the patient was diagnosed with Parsonage-Turner syndrome and Lyrica was prescribed. Over the next 6 weeks the patient_s symptoms improved but then suddenly worsened.The patient returned for follow-up with complaints of recurrent right neck pain and right upper extremity weakness. Neck range of motion was now normal and Spurling_s maneuve...

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Natural History of Brachial Plexus Neuropathy

Cited by 520 publications

References 17 publications

The nonsystemic vasculitic neuropathies

The nonsystemic vasculitic neuropathies

Chiropractic management of a 30-year-old patient with Parsonage-Turner syndrome

Cervical Radiculopathy vs Parsonage–Turner Syndrome: A Case Report

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