Brachial Plexopathy
Brachial plexus dysfunction can occur as a result of trauma, inflammation, malignancies and associated complications. This chapter will discuss various forms of brachial plexopathy, their clinical features, investigations and management.
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31.1 Introduction Brachial plexus is a connecting link between the spinal cord and upper limb. Neurologists frequently encounter a variety of diseases affecting brachial plexus. Trauma to the brachial plexus is perhaps the most common cause in clinical practice. Neuralgic amyotrophy [NA] is a multifocal, immune-mediated, inflammatory peripheral nervous system disorder of brachial plexus. True neurogenic thoracic outlet syndrome is a rare disorder caused by angulation and stretching of the lower plexus by a band or rib (Ferrante 2012a, b) or by scalene muscle hypertrophy (Katirji and Hardy 1995). A traction-induced lower plexopathy can follow sternotomy operations like the coronary artery bypass (Lederman et al. 1982). Lower plexus invasion is frequent in apical lung tumours like bronchogenic carcinoma. Common causes of brachial plexopathy have been summarised in Table 31.1.
Table 31.1 Causes of brachial plexopathy Traumatic brachial plexopathy Idiopathic brachial plexopathy (neuralgic amyotrophy) Hereditary brachial plexopathy (HMSN, hereditary brachial neuritis) Neurogenic thoracic outlet syndrome Radiation-induced brachial plexopathy Intrinsic tumours (Schwannoma, neurofibroma) Extrinsic tumours – benign(desmoids tumours, lipomas, lymphangiomas, haemangiomas and perineuronal cysts) Extrinsic tumours – malignant (recurrences of breast cancer, apical lung tumours, lymphomas, metastatic lymphadenopathy, osteosarcomas and Ewing’s sarcomas)
© Springer Nature Singapore Pte Ltd. 2018 S.V. Khadilkar et al., Neuromuscular Disorders, https://doi.org/10.1007/978-981-10-5361-0_31
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31 Brachial Plexopathy
31.2 Epidemiology Compared with infraclavicular plexopathies, supraclavicular plexopathies are commoner, are associated with closed traction injuries and tend to be severe because greater force is required to produce them (Wilbourn 2005). Upper plexopathies are more common than middle or lower plexopathies, tend to occur in isolation and commonly follow trauma, especially closed traction (Brunelli and Brunelli 1992).
31.3 Clinical Features 31.3.1 Supraclavicular Plexopathy The clinical presentation depends on site of involvement, i.e. supraclavicular or infraclavicular. The deficits of supraclavicular plexopathies tend to resemble those encountered in roots lesions as the lesion is proximal. On the contrary, infraclavicular plexus lesions produce deficits in distribution of one or more terminal nerves. In patients who have sustained trauma, palpation of the neck, axilla, supraclavicular, infraclavicular, and scapular regions for space occupying lesions, bony abnormalities, tenderness and Tinel’s sign are important. The supraclavicular plexus is further divided into upper plexus, middle plexus and lower plexus. Clinical features of supraclavicular lesions are summarised below in Table 31.2. Table 31.2 Clinical features of supraclavicular plexopathy Site of lesion Upper plexus
Middle plexus Lower plexus
Clinical features Weakness occurs in the distribution of affects C5–C6 myotomes affecting external
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