Plexopathy

Plexopathy is a disorder of the network of nerves in the brachial or lumbosacral plexus. Symptoms include pain, loss of motor control (weakness), and sensory deficits (numbness).[1]

Types

There are two main types of plexopathy, based on the location of the symptoms: brachial plexopathy (affecting the arm) and lumbosacral plexopathy (affecting the leg).

Cause

Brachial plexopathy is often caused from local trauma to the brachial plexus, as can happen from a dislocated shoulder. The disorder can also be secondary to compression or stretching of the brachial plexus (for example, during a baby's transit through the birth canal, in which case it may be referred to as Erb's Palsy or Klumpke's palsy).[2] Non-traumatic causes of brachial plexopathy include diabetes, malignancy, and infection.[1] Brachial plexopathy can also be idiopathic with an unknown cause, in which case it is known as Parsonage-Turner Syndrome.[3] Both brachial and lumbosacral plexopathy can also occur as a consequence of radiation therapy,[4] sometimes after 30 or more years have passed, in conditions known as Radiation-induced Brachial Plexopathy (RIBP)[5] and Radiation-induced Lumbosacral Plexopathy (RILP).[6]

Diagnosis

The first steps in the evaluation and management of plexopathy involve a medical provider obtaining a medical history and conducting a physical examination. Diagnosis of plexopathy relies on proper identification of a pattern in motor and sensory function deficits in the upper or lower extremities.[1]

To rule out confounding conditions such as radiculopathy or myelopathy, an MRI of the cervical or lumbar spine is often obtained. If plexopathy is suspected after imaging, an EMG performed by a neurologist or physiatrist can help confirm a plexopathy, and clarify the localization within the brachial or lumbosacral plexus. Following electrodiagnostic testing, further imaging may be obtained of relevant soft tissue structures with either ultrasound or MRI. Some blood tests may help identify the cause of the plexopathy, including screening for diabetes, and obtaining a complete blood count (CBC) and a comprehensive metabolic panel (CMP).[1]

Treatment

Mild cases are usually treated by the administration of analgesia and muscle relaxers. Reduced and limited physical activity with repeated follow-ups with the health care provider are required for one diagnosed with plexopathy. Individuals with prolonged, chronic symptoms will require additional testing and treatment.[1] With brachial plexopathy, surgical decompression may be warranted if the pathophysiology of the disease is causing pressure on the affected nerves. In some cases of brachial plexopathy, no treatment is required and recovery happens on its own.[7] Treatment for lumbosacral plexopathy that is not caused by trauma, but instead from diabetic plexopathy, is directed at controlling the person's blood sugar level. By preventing the deterioration of the nerve fibers from hyperglycemia, patients may recover significant muscle strength.[8] For radiation-induced plexopathies, treatment options are limited to pain/symptom management and provision of assistive devices.

See also

References
  1. Allan B. Wolfson, ed. (2005). Harwood-Nuss' Clinical Practice of Emergency Medicine (4th ed.). pp. 614–615. ISBN 0-7817-5125-X.
  2. "National Institute of Neurological Disorders and Stroke, page on Erb's and Klumpke's Palsies". Retrieved 2021-02-01.
  3. "National Organization for Rare Disorders, page on Parsonage Turner Syndrome". rarediseases.org. Retrieved 2021-02-01.
  4. "Radiation plexopathy - Introduction". www.medmerits.com. Retrieved 2016-03-03.
  5. "Radiation-Induced Brachial Plexopathy: Background, Pathophysiology, Epidemiology". Cite journal requires |journal= (help)
  6. "Radiation-Induced Lumbosacral Plexopathy: Background, Pathophysiology, Epidemiology". Cite journal requires |journal= (help)
  7. "Brachial Plexopathy". Health Guide. The New York Times. 2009-12-09. Retrieved 10 December 2009.
  8. "Lumbosacral Plexopathies: Diagnosis and rehabilitation". BNET. CBS Interactive Inc. 1999. Retrieved 10 December 2009.

 This article incorporates public domain material from the U.S. National Cancer Institute document: "Dictionary of Cancer Terms".

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