Clinical Examination of Brachial and Pelvic Plexus Tumors

Shelly Lwu, M.D., M.Sc., B.Sc.; Rajiv Midha, M.D., M.Sc., F.R.C.S.C.

Disclosures

Neurosurg Focus. 2007;22(6):E5 

In This Article

Abstract and Introduction

Abstract

A thorough history and physical examination are fundamental to the assessment of patients with brachial and pelvic plexus tumors. Typical of most peripheral nerve tumors, the presenting symptoms and signs are few, and if present, can be subtle. Presenting complaints may include a palpable mass lesion, either symptomatic or asymptomatic; sensory alterations; pain; motor deficits; visceral symptoms; or autonomic dysfunction. Motor deficits are usually a late feature in the pathogenesis of this lesion, and a progressive course of pain and significant sensory and motor deficits suggests a malignant pathological process. A detailed family history may reveal familial syndromes and neurocutaneous disorders that predispose the patient to neoplasia, such as neurofibromatosis. The physical examination should be conducted in a systematic fashion, looking for any cutaneous features and motor and sensory deficits. The mass should also be examined for form, consistency, and mobility. An irregular, firm, and immobile mass suggests a malignant lesion. Complete and accurate clinical information must be gathered to pinpoint the anatomical localization of the lesion and formulate a differential diagnosis.

Introduction

A thorough history and physical examination is fundamental to the initial assessment of patients with brachial and lumbar plexus tumors. These tumors, much like other peripheral nerve tumors, usually produce few symptoms and signs, which, if present at all, can be subtle. With a thorough history and systematic neurological examination, the salient features can be elicited. Based on the information acquired from the clinical examination, the anatomical localization can be established and the differential diagnosis formulated. This information in turn leads to directed imaging and electrodiagnostic studies, as discussed in other sections of this issue of Neurosurgical Focus.

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