What is the clinical history of brachial neuritis (BN)?

Updated: May 06, 2020
  • Author: Nigel L Ashworth, MBChB, MSc, FRCPC; Chief Editor: Milton J Klein, DO, MBA  more...
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Answer

See the list below:

  • The onset of pain in brachial neuritis (BN) is often abrupt and may follow recent illness, surgery, [6] 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.

  • Phrenic nerve involvement occurs in up to 5% of cases and can result in significant shortness of breath. [28, 29, 30]

  • Variants of BN can present with isolated or multiple cranial neuropathies (IX, X, XI, XII). [31]

  • 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.


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