Brachial plexopathies: Classification, causes, and consequences

Abstract

The brachial plexus, which is the most complex structure of the peripheral nervous system, supplies most of the upper extremity and shoulder. The high incidence of brachial plexopathies reflects its vulnerability to trauma and the tendency of disorders involving adjacent structures to affect it secondarily. The combination of anatomic, pathophysiologic, and neuromuscular knowledge with detailed clinical and ancillary study evaluations provides diagnostic and prognostic information that is important to clinical management. Since most brachial plexus disorders do not involve the entire brachial plexus but, rather, show a regional predilection, a regional approach to assessment of plexopathies is necessary.

Combined vascular and neurologic injury after cephalic vein cutdown approach for ICD implantation

“…Iatrogenic brachial plexus injuries from surgery and other medical procedures contribute to about 7 to 10 percent of all brachial plexopathies. [10,11] There has been one case in which a patient, after undergoing cardiac resynchronization therapy (CRT) device implantation, complained of "electric shocklike" pain in the left axillary area and was found to have brachial plexus irritation by angulated CRT leads. [12] Classic postoperative paresis from brachial plexopathy can be caused by traction or compression during surgery.…”

“…[12] Classic postoperative paresis from brachial plexopathy can be caused by traction or compression during surgery. [10,13] This typically presents as a painless weakness in the distribution of the upper brachial plexus and can also be accompanied by paresthesias. The lesions are usually a demyelinating conduction block.…”

Dose Constraints to Prevent Radiation-induced Brachial Plexopathy in Patients Treated for Lung Cancer

“…It is well known that peripheral nerves are sensitive to recurrent episodes of trauma, whether from tumor invasion or from surgical intervention [9,15]; multiple traumas might be expected to reduce the threshold for development of symptoms. Unfortunately, these are the very patient likely to justify dose escalation as they often have gross tumor pushing on the nerve, and perhaps the risk is justified because recurrent tumors will also result in further morbidity.…”

“…Brachial plexopathy can present with a wide range of symptoms, often irreversibly, including numbness, pain, parasthesias, and motor impairment [8]. The underlying mechanismis thought to be due to demyelination leading to axon loss [9]. Balancing the benefit of local control with the risk of considerable toxicity is a particular challenge for tumorsof the superior sulcus or tumors with supraclavicular adenopathy.…”

Prognostic value of thumb pain sensation in birth brachial plexopathy

“…However, it has already been noted that patients with sensory deficits carry a grim prognosis 16 . Thumb sensation is related to sensory fibers from the median nerve ascending through the upper trunk and mainly C6 root 17 . Motor impairment of the upper trunk is always present in these patients, including biceps muscle.…”