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Key Features

  • Brachial plexus neuropathy

    • May be idiopathic

    • May follow trauma

    • May result from congenital anomalies, neoplastic involvement, or injury by various physical agents

    • May be familial (rare)

  • Cervical rib syndrome is the compression of the C8 and T1 roots or the lower trunk of the brachial plexus by a cervical rib or band arising from the seventh cervical vertebra

  • Lumbosacral plexus lesions may develop

    • In association with diabetes, cancer, or bleeding disorders

    • After injury

    • Occasionally without known cause

Clinical Findings

  • Brachial plexus neuropathy

    • Initially, severe pain about the shoulder

    • Within days, weakness, reflex changes, and sensory changes, especially involving C5 and C6 develop

    • Symptoms are usually unilateral but may be bilateral

    • Wasting of affected muscles can be profound

  • Cervical rib syndrome

    • Weakness and wasting of intrinsic hand muscles, especially those in the thenar eminence

    • Pain and numbness is in the medial two fingers and the ulnar border of the hand and forearm

    • Compression of the subclavian artery may also occur

  • Lumbosacral plexus lesions

    • Pain and weakness, more so than sensory symptoms

    • Symptoms depend on the level of neurologic involvement

Diagnosis

  • MRI helpful in revealing underlying compressive structure

  • Radiographic films and CT scans

    • Can show a cervical rib or a large transverse process of the seventh cervical vertebra

    • Normal findings do not exclude the possibility of a cervical band

  • Electrodiagnostic evaluation helps localize a lesion and is important for differential diagnosis

Treatment

  • Symptomatic for brachial plexus neuropathy

  • Surgical excision of the rib or band in cervical rib syndrome

  • Physical therapy and adequate analgesia are especially important in idiopathic cases

  • Treat underlying cause

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