Brachial neuritis: Everything you need to know

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Brachial neuritis is nerve damage to the brachial plexus, which is a thick bundle of nerves that feeds the shoulders, hands, and arms.

When nerves sustain damage, they cannot properly carry signals to and from the spinal cord.

This impairment can cause pain, weakness, and unusual sensations, such as tingling or burning.

Brachial neuritis is a type of peripheral neuropathy. Peripheral neuropathy is common among people with diabetes and those with alcohol use disorder, but brachial neuritis is not due to diabetes or alcoholic neuropathy.

Instead, research suggests that it may follow an injury or infection. Although there is usually a trigger for the pain, doctors do not understand why some people get brachial neuritis while others do not.

Brachial neuritis comes in two forms:

• Acute brachial neuritis: Acute brachial neuritis appears suddenly and typically has no known cause. It initially causes sharp, intense pain around the shoulders. Over time, the pain tends to subside, and numbness, tingling, or weakness develops.
• An injury to the brachial plexus: Excessive pressure, stress, or overstretching can injure the brachial plexus. Babies may sustain brachial plexus injuries during birth.

For most people, intense pain is the first symptom of brachial neuritis, and it can start in the shoulder or neck. The pain may radiate down the arms and into the hands or cause pain in the chest. In about two-thirds of cases, it affects just one side of the body.

Some other symptoms include:

• muscle weakness
• poor muscle control
• numbness or tingling in the arm, shoulder, or chest
• unusual sensations in the arms or shoulders

For most people, symptoms disappear with time. However, this can take several months or even years.

Brachial neuritis often appears after the nerves of the brachial plexus sustain damage. In most cases, something in the environment — such as an injury or illness — triggers the symptoms. Doctors do not fully understand why some people develop this syndrome following nerve damage.

Some risk factors for brachial neuritis include:

• Genetics: Research suggests that some forms of brachial neuritis are genetic, including a syndrome called hereditary neuralgic amyotrophy. The gene for this condition is dominant, which means that only one parent needs to be a carrier to pass the disease on to a child. Even when a person carries the gene for hereditary neuralgic amyotrophy, they may not develop symptoms until an injury or illness activates the gene.
• Recent infection: Various studies estimate that 25–55% of brachial neuritis cases follow an infection. Upper respiratory infections commonly precede brachial neuritis. Some other illnesses that experts have linked to this condition include smallpox, HIV, typhoid, and the flu.
• Age: Brachial neuritis can appear at any age. In many cases, a person develops symptoms either in their 20s or 60s.
• Autoimmune disorder: Autoimmune diseases cause the immune system to attack healthy tissue. Autoimmune diseases may contribute to brachial neuritis. Some research suggests that damage to myelin, which is the protective covering of nerves, is responsible for some forms of brachial neuritis. A type of brachial neuritis called Parsonage-Turner syndrome often occurs without an obvious cause, and experts have proposed an association with autoimmune inflammation.
• Sex: Males are more likely than females to develop brachial neuritis. Estimates of the male-to-female prevalence ratio vary a lot, ranging from 2-to-1 to 11.5-to-1.
• Other causes: Other factors that stress or injure the nerves and muscles may increase the risk. Some research has linked pregnancy and strenuous exercise to brachial neuritis. Babies may also injure the brachial plexus during birth.

To diagnose brachial neuritis, a doctor will typically take a complete medical history to find out about the person’s recent injuries, illnesses, and vaccinations.

If a doctor suspects brachial neuritis or another nerve issue, they may recommend nerve testing to assess the health of the nerves. This testing might include a type of test called electromyography, which uses a device to record and measure nerve signals.

They may also order additional tests to rule out other causes. Some common tests include:

• blood work to test for infections and autoimmune disorders
• X-rays to assess the health and structure of nearby bones and joints
• other imaging scans, such as CT or MRI scans, to look at the muscles and other soft tissues

Brachial neuritis usually gets better on its own. Treatment focuses on managing the pain and weakness until the symptoms improve. Some treatments that may help include:

• nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen and acetaminophen
• injections with corticosteroids
• physical therapy
• transcutaneous electrical nerve stimulation (TENS), a procedure that stimulates the nerves to reduce pain
• cold therapy
• lifestyle changes, including regular exercise and relaxation techniques, such as meditation and yoga

When brachial neuritis appears after an injury to the brachial plexus, early surgery may repair the damage and prevent permanent brachial neuritis from developing.

There is no evidence that brachial neuritis causes other illnesses or can lead to serious long term complications. However, the symptoms of brachial neuritis may alter a person’s movement, increasing the risk of further injuries.

Although doctors can usually treat the pain of neuritis, managing muscle weakness is more difficult. A person may need to change their daily activities and routines, and they might require accommodations at work or school.

Brachial neuritis may change over time. The pain usually subsides, making way for weakness, tingling, or numbness. However, brachial neuritis does not spread and will not cause nerve pain in other areas of the body.

Brachial neuritis is not typically a sign of a serious underlying medical condition, but it does often follow a shoulder or nerve injury.

Prompt treatment can help with symptoms, particularly when brachial neuritis follows a physical injury, as surgery may treat the injury and prevent symptoms from worsening.

Brachial neuritis may mimic the symptoms of other diseases, so it is important to get an accurate diagnosis and not to ignore signs of nerve pain. A doctor can recommend treatment options to relieve pain and discomfort.