Brachial plexitis (brachial neuritis) is irritation or inflammation of the brachial plexus: the bundle of nerves that leaves the neck and reaches the arm. It typically starts with sudden, severe pain in the shoulder, which eases after days or weeks and leaves weakness in some muscles. In everyday speech, the word “plexitis” is also used for any shoulder and arm pain that comes from a nerve. A neurologist makes the diagnosis.
Symptoms
- Sudden, severe pain in the shoulder, shoulder blade or upper arm, often at night.
- Weakness when you lift your arm or bend your elbow, once the pain has eased.
- Numbness or reduced sensation in the arm.
- The shoulder blade sticks out at the back (winged shoulder blade).
- Weakening and thinning of some of the muscles around the shoulder.
The pain and the weakness don’t come at the same time. Usually 1–3 weeks of severe pain come first, and the weakness shows up when the pain is already easing. That is why many people think the shoulder is getting better, until they find that they can’t lift the arm. Sensation may be reduced in a patch on the side of the shoulder or on the upper arm.
Why it happens
The cause isn’t always clear. Brachial plexitis can appear:
- after a viral infection, a vaccination or an operation (neuralgic amyotrophy, also called Parsonage–Turner syndrome);
- after an injury: a fall onto the shoulder, a sudden pull on the arm, a car accident;
- from pressure, for example from carrying a heavy backpack or lying for a long time in an awkward position;
- less often with diabetes or other illnesses.
Neuralgic amyotrophy is more common in men and usually affects one arm. Most people get back much of their strength, but it takes months.
How we treat it
You can start with a consultation with Kaloyan. If he thinks it is needed, he will refer you to a neurologist and for a nerve test (EMG), which shows which nerves are affected and how badly. Kaloyan checks the strength of each muscle separately, and the mobility of your shoulder and neck. The core of the treatment is kinesitherapy for nerve pain (neuralgia), which means exercise and manual therapy. Here that is gentle exercises that keep the joint mobile, then gradual strengthening of the weakened muscles once the nerve starts to recover.
Electrotherapy helps with the pain, and ultrasound therapy helps the irritated tissues around the shoulder. Nerves recover slowly, usually over months, so the treatment is longer than for muscle pain. Visits are more frequent at the start and then spread out, while the exercises at home take over most of the work. All along, Kaloyan keeps track of which muscles are getting their strength back and adjusts the exercises. If you have a new EMG during treatment, bring it: it shows how the nerve is recovering.
What you can do yourself
- Keep your shoulder moving within the range that doesn’t hurt, so that it doesn’t stiffen.
- In the acute phase, avoid carrying anything heavy with that arm.
- Do the home exercises regularly, but don’t tire the weakened muscles.
- If your arm is numb, be careful with heat pads and ice: sensation is reduced and you can burn yourself without feeling it.
- Write down what you can already do with the arm. Change is slow, and this makes it easier to notice.
When to see a doctor first
A neurologist diagnoses brachial plexitis. See a doctor before kinesitherapy if:
- the shoulder pain is sudden and very severe;
- the arm is getting weaker quickly;
- the pain is in the left shoulder and comes with shortness of breath or chest pain (then get emergency help);
- you have a fever, or the pain came after an injury;
- the numbness affects both arms or the legs.
