Plexopathies

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

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

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

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