Acute brachial neuritis

Acute brachial neuritis (neuralgic amyotrophy, Parsonage-Turner syndrome) is an uncommon painful plexopathy that is probably caused by an immune-mediated neuritis. It usually presents as acute severe pain (often at night) in the shoulder and upper arm on one side. Acute brachial neuritis can follow an upper respiratory tract infection, vaccination or local trauma. Within 1 to 4 days the patient may have a patch of numbness and weakness in some muscles, especially around the shoulder girdle. Severe pain persists for days or weeks, and affected muscles can waste.

In the acute stage, diagnosis is largely based on clinical presentation, but imaging (including high-resolution ultrasound or magnetic resonance imaging) can be useful. Magnetic resonance imaging has been reported to show T2 hyperintensity in affected nerves and oedema in affected muscles, and helps exclude nerve root compression.

Motor recovery can take months and may not be complete.

Treatment for acute brachial neuritis is mainly supportive, and includes physiotherapy. Corticosteroids can help relieve pain and improve time to recovery, but it is not known whether they improve the extent of motor recovery. Use:

To treat neuropathic pain, see advice.