Plexopathy

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Plexopathy is a disorder of the network of nerves in the brachial or lumbosacral plexus. Symptoms include pain, muscle weakness, and sensory deficits (numbness). [1]

Contents

Types

There are two main types of plexopathy, based on the location of the symptoms: brachial plexopathy (affecting the arm) and lumbosacral plexopathy (affecting the leg).

Cause

Brachial plexopathy is often caused from local trauma to the brachial plexus, as can happen from a dislocated shoulder. The disorder can also be secondary to compression or stretching of the brachial plexus (for example, during a baby's transit through the birth canal, in which case it may be referred to as Erb's Palsy or Klumpke's palsy). [2] Non-traumatic causes of brachial plexopathy include diabetes, malignancy, and infection. [1] Brachial plexopathy can also be idiopathic with an unknown cause, in which case it is known as Parsonage-Turner Syndrome. [3] Both brachial and lumbosacral plexopathy can also occur as a consequence of radiation therapy, [4] sometimes after 30 or more years have passed, in conditions known as Radiation-induced Brachial Plexopathy (RIBP) [5] and Radiation-induced Lumbosacral Plexopathy (RILP). [6]

Diagnosis

The first steps in the evaluation and management of plexopathy involve a medical provider obtaining a medical history and conducting a physical examination. Diagnosis of plexopathy relies on proper identification of a pattern in motor and sensory function deficits in the upper or lower extremities. [1]

To rule out confounding conditions such as radiculopathy or myelopathy, an MRI of the cervical or lumbar spine is often obtained. If plexopathy is suspected after imaging, an EMG performed by a neurologist or physiatrist can help confirm a plexopathy, and clarify the localization within the brachial or lumbosacral plexus. Following electrodiagnostic testing, further imaging may be obtained of relevant soft tissue structures with either ultrasound or MRI. Some blood tests may help identify the cause of the plexopathy, including screening for diabetes, and obtaining a complete blood count (CBC) and a comprehensive metabolic panel (CMP). [1]

Treatment

Management of brachial or lumbosacral plexopathy depends on the underlying cause. No matter the cause of plexopathy, physical therapy and/or occupational therapy may promote recovery of strength and improve limb function. In the case of a mass lesion causing compression of the brachial or lumbosacral plexus, surgical decompression may be warranted. In an idiopathic brachial plexopathy, no specific treatment is usually indicated, although there is limited evidence that steroids may hasten recovery. [7] [8] If a brachial or lumbosacral plexopathy is determined to be caused by diabetes, management includes controlling the patient's blood sugar. [9] For radiation-induced plexopathies, treatment options are often limited to pain/symptom management and provision of assistive devices.

See also

Related Research Articles

<span class="mw-page-title-main">Brachial plexus</span> Network of nerves

The brachial plexus is a network of nerves formed by the anterior rami of the lower four cervical nerves and first thoracic nerve. This plexus extends from the spinal cord, through the cervicoaxillary canal in the neck, over the first rib, and into the armpit, it supplies afferent and efferent nerve fibers to the chest, shoulder, arm, forearm, and hand.

The ankle jerk reflex, also known as the Achilles reflex, occurs when the Achilles tendon is tapped while the foot is dorsiflexed. It is a type of stretch reflex that tests the function of the gastrocnemius muscle and the nerve that supplies it. A positive result would be the jerking of the foot towards its plantar surface. Being a deep tendon reflex, it is monosynaptic. It is also a stretch reflex. These are monosynaptic spinal segmental reflexes. When they are intact, integrity of the following is confirmed: cutaneous innervation, motor supply, and cortical input to the corresponding spinal segment.

Hyperinsulinemic hypoglycemia describes the condition and effects of low blood glucose caused by excessive insulin. Hypoglycemia due to excess insulin is the most common type of serious hypoglycemia. It can be due to endogenous or injected insulin.

<span class="mw-page-title-main">Klumpke paralysis</span> Medical condition

Klumpke's paralysis is a variety of partial palsy of the lower roots of the brachial plexus. The brachial plexus is a network of spinal nerves that originates in the back of the neck, extends through the axilla (armpit), and gives rise to nerves to the upper limb. The paralytic condition is named after Augusta Déjerine-Klumpke.

<span class="mw-page-title-main">Erb's palsy</span> Paralysis of the arm usually caused during birth

Erb's palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5–C6 nerves. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5–C8 and thoracic nerve T1. These injuries arise most commonly, but not exclusively, from shoulder dystocia during a difficult birth. Depending on the nature of the damage, the paralysis can either resolve on its own over a period of months, necessitate rehabilitative therapy, or require surgery.

<span class="mw-page-title-main">Monoplegia</span> Paralysis of a single limb

Monoplegia is paralysis of a single limb, usually an arm. Common symptoms associated with monoplegic patients are weakness, numbness, and pain in the affected limb. Monoplegia is a type of paralysis that falls under hemiplegia. While hemiplegia is paralysis of half of the body, monoplegia is localized to a single limb or to a specific region of the body. Monoplegia of the upper limb is sometimes referred to as brachial monoplegia, and that of the lower limb is called crural monoplegia. Monoplegia in the lower extremities is not as common of an occurrence as in the upper extremities. Monoparesis is a similar, but less severe, condition because one limb is very weak, not paralyzed. For more information, see paresis.

<span class="mw-page-title-main">Sacral plexus</span> Nerve plexus

In human anatomy, the sacral plexus is a nerve plexus which provides motor and sensory nerves for the posterior thigh, most of the lower leg and foot, and part of the pelvis. It is part of the lumbosacral plexus and emerges from the lumbar vertebrae and sacral vertebrae (L4-S4). A sacral plexopathy is a disorder affecting the nerves of the sacral plexus, usually caused by trauma, nerve compression, vascular disease, or infection. Symptoms may include pain, loss of motor control, and sensory deficits.

<span class="mw-page-title-main">Brachial plexus injury</span> Medical condition

A brachial plexus injury (BPI), also known as brachial plexus lesion, is an injury to the brachial plexus, the network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand. These nerves originate in the fifth, sixth, seventh and eighth cervical (C5–C8), and first thoracic (T1) spinal nerves, and innervate the muscles and skin of the chest, shoulder, arm and hand.

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<span class="mw-page-title-main">Empty sella syndrome</span> Medical condition

Empty sella syndrome is the condition when the pituitary gland shrinks or becomes flattened, filling the sella turcica with cerebrospinal fluid instead of the normal pituitary. It can be discovered as part of the diagnostic workup of pituitary disorders, or as an incidental finding when imaging the brain.

<span class="mw-page-title-main">Radial neuropathy</span> Human disease

Radial neuropathy is a type of mononeuropathy which results from acute trauma to the radial nerve that extends the length of the arm. It is known as transient paresthesia when sensation is temporarily abnormal.

<span class="mw-page-title-main">Parsonage–Turner syndrome</span> Medical condition

Parsonage–Turner syndrome, also known as acute brachial neuropathy, neuralgic amyotrophy and abbreviated PTS, is a syndrome of unknown cause; although many specific risk factors have been identified, the cause is still unknown. The condition manifests as a set of symptoms most likely resulting from autoimmune inflammation of unknown cause of the brachial plexus.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

<span class="mw-page-title-main">Hereditary neuralgic amyotrophy</span> Medical condition

Hereditary neuralgic amyotrophy (HNA) is a neuralgic disorder that is characterized by nerve damage and muscle atrophy, preceded by severe pain. In about half of the cases it is associated with a mutation of the SEPT9 gene (17q25). While not much is known about this disorder, it has been characterized to be similar to Parsonage-Turner syndrome in prognosis.

<span class="mw-page-title-main">Magnetic resonance neurography</span>

Magnetic resonance neurography (MRN) is the direct imaging of nerves in the body by optimizing selectivity for unique MRI water properties of nerves. It is a modification of magnetic resonance imaging. This technique yields a detailed image of a nerve from the resonance signal that arises from in the nerve itself rather than from surrounding tissues or from fat in the nerve lining. Because of the intraneural source of the image signal, the image provides a medically useful set of information about the internal state of the nerve such as the presence of irritation, nerve swelling (edema), compression, pinch or injury. Standard magnetic resonance images can show the outline of some nerves in portions of their courses but do not show the intrinsic signal from nerve water. Magnetic resonance neurography is used to evaluate major nerve compressions such as those affecting the sciatic nerve (e.g. piriformis syndrome), the brachial plexus nerves (e.g. thoracic outlet syndrome), the pudendal nerve, or virtually any named nerve in the body. A related technique for imaging neural tracts in the brain and spinal cord is called magnetic resonance tractography or diffusion tensor imaging.

Anterior interosseous syndrome is a medical condition in which damage to the anterior interosseous nerve (AIN), a distal motor and sensory branch of the median nerve, classically with severe weakness of the pincer movement of the thumb and index finger, and can cause transient pain in the wrist.

<span class="mw-page-title-main">Nerve compression syndrome</span> Human medical condition

Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by chronic, direct pressure on a peripheral nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression. Its symptoms include pain, tingling, numbness and muscle weakness. The symptoms affect just one particular part of the body, depending on which nerve is affected. The diagnosis is largely clinical and can be confirmed with diagnostic nerve blocks. Occasionally imaging and electrophysiology studies aid in the diagnosis. Timely diagnosis is important as untreated chronic nerve compression may cause permanent damage. A surgical nerve decompression can relieve pressure on the nerve but cannot always reverse the physiological changes that occurred before treatment. Nerve injury by a single episode of physical trauma is in one sense an acute compression neuropathy but is not usually included under this heading, as chronic compression takes a unique pathophysiological course.

Birth injury refers to damage or injury to the child before, during, or just after the birthing process. "Birth trauma" refers specifically to mechanical damage sustained during delivery.

Cancer pain can be caused by pressure on, or chemical stimulation of, specialised pain-signalling nerve endings called nociceptors, or by damage or illness affecting nerve fibers themselves.

<span class="mw-page-title-main">Radiation-induced lumbar plexopathy</span> Type of nerve damage

Radiation-induced lumbar plexopathy (RILP) or radiation-induced lumbosacral plexopathy (RILSP) is nerve damage in the pelvis and lower spine area caused by therapeutic radiation treatments. RILP is a rare side effect of external beam radiation therapy and both interstitial and intracavity brachytherapy radiation implants.

References

  1. 1 2 3 4 Allan B. Wolfson, ed. (2005). Harwood-Nuss' Clinical Practice of Emergency Medicine (4th ed.). Lippincott Williams & Wilkins. pp. 614–615. ISBN   0-7817-5125-X.
  2. ↑ "National Institute of Neurological Disorders and Stroke, page on Erb's and Klumpke's Palsies" . Retrieved 2021-02-01.
  3. ↑ "National Organization for Rare Disorders, page on Parsonage Turner Syndrome". rarediseases.org. Retrieved 2021-02-01.
  4. ↑ "Radiation plexopathy - Introduction". www.medmerits.com. Retrieved 2016-03-03.
  5. ↑ Stephenson, Ryan O (2024-01-31). "Radiation-Induced Brachial Plexopathy: Practice Essentials, Pathophysiology, Epidemiology". Medscape Reference. Retrieved 2024-08-08.
  6. ↑ Yadav, Rajesh R (2023-09-05). "Radiation-Induced Lumbosacral Plexopathy: Practice Essentials, Pathophysiology, Epidemiology". Medscape Reference. Retrieved 2024-08-08.
  7. ↑ "Brachial Plexopathy". Health Guide. The New York Times. 2009-12-09. Retrieved 10 December 2009.
  8. ↑ Feinberg, J. H.; Radecki, J. (2010). "Parsonage-Turner Syndrome". HSS Journal. 6 (2): 199–205. doi:10.1007/s11420-010-9176-x. PMC   2926354 . PMID   21886536.
  9. ↑ "Lumbosacral Plexopathies: Diagnosis and rehabilitation". BNET. CBS Interactive Inc. 1999. Retrieved 10 December 2009.

PD-icon.svg This article incorporates public domain material from Dictionary of Cancer Terms. U.S. National Cancer Institute.

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