Brachial Plexitis -Procedures, Side effects, Recovery time, Costs and alternatives

Brachial plexitis is a condition that is synonymous with the onset of severe shoulder pain. The pain in the shoulder is followed by a sensory loss and weakness of the shoulder muscles. This condition of the shoulder can also be addressed as brachial radiculitis, parsonage-turner syndrome, acute brachial neuropathy, and neuralgic amyotrophy. There are two forms of the disease one is hereditary and the other is an idiopathic form. The hereditary form occurs due to dominant autosomal.

However, the idiopathic form of the disease can occur due to any recentviral infection, vaccination, and infection of the upper respiratory tract. Other problems which may be a cause of brachial plexitis include post-surgical plexopathy and strenuous exercise. The infections which may cause the development of the disease include influenza, typhoid fever, smallpox, Borrelia burgdorferi, cytomegalovirus, coxsackievirus, and parvovirus B19. Brachial plexitis may also occur after vaccination. This condition mostly affects males. The pain associated with the condition is constant but the intensity of the pain varies. In the majority of the patients, the onset of weakness in the muscles is sudden. However, it may also coincide with the pain. In nearly 70 percent of the cases, the weakness in the muscles is reported within 2 weeks of the staring of pain. This condition mostly affects the people in the age group of 30 to 70 years.

There are no lab tests for diagnosing this condition. However, a doctor may prescribe electromyography, nerve conduction study, or MRI to look for indications related to the disease. The treatment options available for curing brachial plexitis include the use of medicines, physiotherapy exercises, and surgical procedure like nerve grafting surgery. The doctor may prescribe a treatment based on the age and severity of the condition. A medical history of the patient may also be considered before deciding the best line of treatment for the condition.

The treatment for brachial plexitis can be attained through pain medications, physiotherapy, and in cases of severe complexity, a surgical procedure can be performed.

• Medications: A doctor may advise pain-relieving medications to the patient suffering from the excruciating pain of shoulder due to brachial plexitis. In pain reliever medications the doctor prefers the use of nonsteroidal anti-inflammatory drugs as the initial treatment for relieving the pain. If non-steroidal anti-inflammatory drugs do not provide the necessary relief then a doctor may prescribe some nerve pain medications like gabapentin, and pregabalin. A doctor may also prescribe a corticosteroid during the early stages of the disease as studies over the years have revealed that making use of corticosteroid may not only provide relief in the pain but it also helps in the recovery of weak muscles.
• Physiotherapy: If there is no improvement in the condition of the patient then a doctor may advise a patient to undergo physiotherapy sessions. Based on the pain and weakness in the muscles of the patient the physiotherapist decides which range of motion exercise would be best suited for the patient. A physiotherapist makes the patient undergo some cervical isometric exercises, cervical mobilization exercises and a range of scapular exercises. A TENS (Transcutaneous electrical stimulation) device may be used by the physiotherapist for the rehabilitation of the patient. The electrical signals are sent to the electrodes attached to the skin through wires. The objective of this technique is to reduce pain.
• Functional Electrical Stimulation technique may also be used for reducing the weakness of the muscles. In this technique, small electrical charges are given to the weak muscles. This helps in restoring the functionality of the weak muscles.
• Surgical intervention: If after undergoing treatment involving physiotherapy and corticosteroid medications the weakness of the muscles do not show any sign of improvement then a doctor may prescribe surgery for the affected part. The patient may have to undergo nerve graft or tendon transfer based on the complexity of the condition. In nerve grafting surgery healthy nerves from another part of the body are taken and drafted into the area of muscle weakness.

A patient is considered eligible for treatment of brachial plexitis if the lists of following symptoms are exhibited:

• A patient is experiencing pain in the shoulder that is radiating to the upper arm.
• A patient is having pain his/her neck that is radiating downwards into the shoulders and arms.
• A patient having pain in the region of posterior chest wall which is radiating through to the anterior chest wall or vice versa.
• Pain in the lower brachial plexus region.
• A patient experiencing weakness in the muscles.
• Loss of sensations in the muscles.

A doctor would also run some diagnostic tests like MRI to gauge the eligibility of the patient for the treatment.

A person who is not showing any signs or symptoms associated with the brachial plexitis is considered not eligible for the treatment. A patient that is allergic to the use of non-steroidal anti- inflammatory medications or the use of corticosteroid is considered not eligible for treatment through medicines. A patient with weak immunity is considered not eligible for the treatment of the condition through surgical procedures.

Almost every treatment ranging from medication to surgical procedure has some minor and major side effects associated with it. The chance of occurrence of the side effects varies from patient to patient. If a patient experiences a minor side effect then in usual cases the side effect subsides after a short duration of time. In case a serious side effect is experienced then a doctor must be informed promptly.

The side effects of using non-steroidal anti-inflammatory drugs include a severe headache, pain in the stomach, increased blood pressure, allergic reactions like skin rashes and blisters, dizziness, etc. Making use of corticosteroids for treating weak muscles involves side effects such as weight gain, thinning of the skin, increased blood pressure, glaucoma, osteoporosis, etc.

Side effects associated with treating the patient through physiotherapy include patient exhibiting fatigue, soreness in muscles, and pain in the regionwhere exercise is being conducted. The side effects associated with surgical treatment include surgical site infection, loss of blood, pain at the surgical site, etc.In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.

A very pivotal role is played by post-treatment guidelines in the recovery of the patient. Post- treatment guidelines are given by the doctor after the treatment for a specific condition gets completed. It is essential that a patient religiously follows post-treatment guidelines as it helps in preventing the disease from occurring in the future. Some of the post-treatment guidelines which a patient is required to follow are given below:

• The pain medications must be taken as advised by the doctor.
• The exercise routine should not be stopped abruptly. The routine must continue further for some time and then withdrawn gradually.
• In the case of surgical treatment, hygiene must be maintained at the surgical site.
• With regards to surgical treatment, a complete course of antibiotic must be done
• Foods that help in improving the nervous system must be included in the diet.

A patient suffering from brachial plexitis recovers slowly. It may take several months for the patient to recover properly. The recovery period in patients also varies based on the complexity of the condition. During the initial phase of the treatment the recovery may be slow but with a continuous line of treatment the recovery may gradually pick up. However, a patient may recover early if he/she undergoes a successful surgical treatment.

The average cost of pain killers belonging to the category of non-steroidal anti-inflammatory drugs ranges from 50 to 200 rupees. An average cost of physiotherapy sessions in India varies from cities to cities. In small cities, a physiotherapy session may cost in the range of 250 to 500 rupees.

However, in metro cities, the cost of physiotherapy session may range from 600 to 2000 rupees per session based on the experience of the physiotherapist. The average price of nerve grafting surgery in India costs around 3,00,000 rupees which is inclusive of all the costs associated with the surgery.

The results of the treatment for a patient suffering from the problem of brachial plexitis are not permanent. There is a chance that this condition may reoccur in the future as brachial plexitis can occur due to an infection or any vaccination received by a patient.

The treatments described above are sufficient for curing the patient suffering from brachial plexitis. However, a patient may also opt for a different line of treatment like acupressure, and acupuncture. These treatments are not only helpful in providing relief but they also help in improving the muscle weakness. Taking b-complex capsules help in improving the functionality of the nerves thereby reducing muscle weakness. A patient may also use ice or heat therapy for reducing the pain and stiffness associated with the disease.