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Brachial neuritis (neuralgic amyotrophy)
💥 Brachial neuritis (neuralgic amyotrophy) is an acute inflammatory disorder of the brachial plexus. It typically presents with sudden, severe shoulder pain followed by muscle weakness and wasting. It may be triggered by infection, vaccination, or immune-mediated processes.
📖 About
- Inflammatory condition affecting the brachial plexus.
- Often post-infective or post-immune in origin, but the precise cause remains unclear.
- May be unilateral or bilateral; recurrence is possible in some patients.
🩺 Clinical Features
- ⚡ Severe acute shoulder pain lasting 1–3 days, often the first symptom.
- ➡️ Pain is followed by rapid-onset weakness and muscle wasting in the shoulder and upper arm.
- Commonly affected muscles: deltoid, supraspinatus, infraspinatus, and others supplied by the plexus.
- 🤲 Sensory changes: may occur but are usually mild compared with motor weakness.
🧠 Anatomy: Brachial Plexus
🔍 Investigations
- CXR / CT Chest: To exclude compressive lesions such as a Pancoast tumour.
- Electromyography (EMG): Detects denervation in affected muscles and supports the diagnosis.
⚖️ Differentials
- Cervical radiculopathy
- Rotator cuff tear
- Traumatic or malignant plexopathy
💊 Management
- Steroids: Sometimes given in the acute phase to reduce inflammation (evidence limited).
- Pain relief: NSAIDs or stronger analgesia as needed during acute pain phase.
- Physiotherapy: Essential for recovery – strengthens weak muscles, maintains shoulder mobility, and prevents contractures.
- 🕒 Prognosis: Most recover over weeks to months, though some patients are left with persistent weakness or muscle wasting.
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