Monday, May 11, 2009

I've been diagnosed - Brachial Neuritis

I'll be limited to my range of motion and have a jacked up shoulder blade for awhile. The dr said hopefully I'll have 80% of it restored after the 1st year. Umm those that know me know I'll try and make that happen before. Please, a year!?! More or less a virus attacked my central nervous system and paralized specific nerves. Who knew this could happen? Not me...
Brachial Neuritis:
Background
Brachial neuritis (BN) is a rare syndrome of unknown etiology affecting mainly the lower motor neurons of the brachial plexus and/or individual nerves or nerve branches. BN usually is characterized by the acute onset of excruciating unilateral shoulder pain, followed by flaccid paralysis of shoulder and parascapular muscles several days later. The syndrome can vary greatly in presentation and nerve involvement.
Pathophysiology
Brachial neuritis (BN) exists in an inherited and an idiopathic form. In the idiopathic version, the pathophysiology is unknown, but the condition is generally thought to be an immune system – mediated inflammatory reaction against nerve fibers of the brachial plexus. Axonopathy with subsequent Wallerian degeneration appears to predominate, but proximal conduction block has also been described in over 33% of cases in the series by Lo and Mills. The inherited form is autosomal dominant and has been linked to mutations in the SEPT9 gene on chromosome 17q. Septins are involved in the formation of the cytoskeleton and in cell division, but how these mutations result in BN is unknown.
Frequency
United States
The incidence of brachial neuritis is approximately 1-2 cases per 100,000 person-years.
International
In the United Kingdom, the incidence of brachial neuritis (BN) is approximately 3 per 100,000 person-years. BN has also been described in many countries around the world, although specific rates of incidence have not been reported.
Mortality/Morbidity
Brachial neuritis is not a fatal condition, although the phrenic nerve may be involved. The risk of significant residual disability in the involved limb after 2 years is approximately 10-20%.
Sex
Brachial neuritis occurs predominantly in males, with the male-to-female ratio for the condition ranging from 2:1 to 4:1.
Age
Brachial neuritis (BN) has been reported in individuals from age 3 months to 74 years; however, the condition's prevalence is highest in young to middle-aged adults. Onset in childhood should be considered suggestive of hereditary BN.
Clinical
History
The onset of pain in brachial neuritis (BN) is often abrupt and may follow recent illness, surgery, immunization, or even trauma (see Causes, below). Up to two thirds of cases begin during the nighttime.
The pain usually is localized to the right shoulder region, but it may be bilateral in 10-30% of cases.
The pain's intensity is very high (9+/10) and is maximal at onset.
Usually, the pain is described as sharp or throbbing in nature.
The pain usually is constant, but it is exacerbated by movements of the shoulder. Movements of the neck, coughing, and/or sneezing usually do not worsen the pain.
Intense pain can last from a few hours to several weeks and requires opiate analgesia.
Low-grade pain may persist for up to a year.
As the pain subsides, weakness becomes apparent.
In most cases of BN, this weakness manifests within about 2 weeks of onset.
Weakness is maximal at onset but can progress over 1 or more weeks.
A wide variety of muscles is affected, particularly those innervated by the upper trunk. The supraspinatus, infraspinatus, serratus anterior, and deltoid muscles are particularly susceptible, but many different single and multiple combinations of muscle involvement, including a pure distal form, have been reported.
The patient may notice considerable atrophy and wasting, as well as a deep aching in the affected muscles.
Numbness may occur, depending on the particular nerves affected, and usually is found in the nerve distribution corresponding to maximal muscle weakness. However, numbness is rarely a prominent complaint.
In 25-50% of patients, the medical history indicates a viral illness or vaccination that occurred days or weeks prior to the onset of symptoms. Some patients also may note recent trauma or severe exercise, surgery, infection, or immunization.
Physical
Due to the extreme pain involved, patients with brachial neuritis usually present acutely. Typically, the affected arm is supported by the uninvolved arm and is held in adduction and internal rotation.
Atrophy of the affected muscles becomes prominent after approximately 2 weeks.
Considerable muscle pain may be noted on palpation.
Passive and active attempts at shoulder and scapular movement result in a significant increase in pain. Movements of the neck are relatively pain free.
Muscle strength in affected muscles often is reduced severely (to 2 or less on the Medical Research Council [MRC] grading scale).
Reflexes may be reduced or absent, depending on which nerves are involved.
Sensory loss is not prominent but may be detectable (in particular, loss of axillary nerve sensation), depending on the specific nerves affected

18 comments:

Susan Entwisle said...
This comment has been removed by the author.
Kellie said...

Hi Susan,
I did 4 or 5 treatments of acupuncture and it took all my pain away. I have zero pain now! You really should look into it.

Melanie Papworth said...

ugh. i am so sorry!!!!!!!!!!!!!!!!!!!!!!!!!!!

The Booher Family said...

Holy crap! I'm really sorry that you have this wacked out diagnosis, but I'm glad that you finally know what the heck is going on with your body! Hope you heal quick!

Tweedle Beetle Tri-Athletle said...

Hi Kellie,

I have just been diagnosed with Brachial Neuritis and as a triathlete, I am stressing out of my mind. You mentioned that your acupuncturist was able to make a difference? I too see an acupuncturist but the pain has only been managed through prescriptions. Have you experience any of the muscle wasting? I would love to hear your thoughts on how to proceed...

Very best...

Tweedle Beetle Tri-Athletle

Tweedle Beetle Tri-Athletle said...

Hi Kellie,

I am just beginning to deal with this awful affliction. As I noted in my last comment, I was diagnosed with Brachial Neuritis after an I woke up in agony two weeks ago. I am hoping to have this diagnosis confirmed today after an MRI and Nerve Conduction Test with a Neurologist. I have dedicated my blog:

http://tweedlebeetletriatheletle.blogspot.com/

to communicating my trials as I battle this issue (I really don’t even know what it is) and I am hoping to pull as many people who are afflicted with it to my blog and offer this space as a forum and community to help each other.

Please stop by if you have any thoughts, rants, feelings, recommendations or just words of encouragement!!!

Thanks… Tweedle Beetle

Unknown said...

Hi, Been living with BN for nearly 18 months now, still affects me in waves of pain and tingling for 1-3 weeks, then disappears almost completely for 3-4 weeks.

Anyone else with the same pain pattens?

Anyone with any treatments or ways to prevent remission?!

Much appreciated,

Mark.

Sam Kirby said...


Hi Kellie and Susan
Have you managed to carry on running with BN? I am a runner and have had BN for about a month now and not running is driving me mad. Thinking about strapping it up and running but not sure if that is wise and would like to hear ofa anyone else's experiences of that. Thanks Sam

Anonymous said...

Do what you feel is best for you

Anonymous said...

Please help with answers

Stressed out and weary said...

Hello everyone,
I have been diagnosed with this same issue. I am searching the web to see if acupuncture will resolve my impairment which is loss of movement to 3 fingers. I noticed the date on everyone's comments and time has lapsed. I would love to hear any success stories or the status of the conditions.

sincerely
Stressed out

parul said...
This comment has been removed by the author.
Susan said...

I am 3 years and 2 months into having brachial neuritis. I had a right winged scapula and was unable to lift my arm up over my head for about 14 months. Currently i have residual weakness and numbness in my right shoulder, arm and hand but my hand symptoms are the most troubling. I have had persistent, non-abating tingling and numbness, and stiffness, in my right hand/fingers/thumb since the onset of this condition in early 2013. Some reports I have found on the web say a severe case involving the hand can take "several" years to resolve. I am still hopeful I will improve but at 3 years, I have been accepting that I may have to live with a permanent disability.

Unknown said...

I've been diagnosed with BN 4 times now and after a long process of figuring out how to properly treat it this is what I found.
If you are still in pain get a 9 day prescription of prednizone. This will stop your body from attacking your nerves and begin the healing process. If you catch it before you lose function youre in the clear but if you did lose function you will have to wait for the nerves to repair themselves.
I notice that the pain lasted through the entire 9 day prescription.
If you've lost function and are no longer in pain the prednizone won't do you any good.
I hope this helps.

Stressed out and weary said...

I have been diagnosed with BN in 2014. The neurologist said I should wait it would get better over time. Well its 2016 and 4 surgeries and I have about 30% of mobility in my left hand. The surgeon wants to go back in my hand to see if they're any good tendons to connect to the ones that are dead.. At this point I don't know what to do....Any advise!!

AM said...

Hi! Did anyone on this blog with brachial neuritis go back to work? Were you booked off work initially, and for how long? Did you resign or change jobs?

Unknown said...

Hi, My son has BN as a result of flu attack. His right hand mobility is diminished by 70%. Any advice? How reliable is acupuncture for this condition?

Peter weller said...

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