Neoplastic Brachial Plexopathy
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Neoplastic brachial plexopathy (NBP) is an uncommon diagnosis in most physiatrists’ offices, but the condition bears review as it can mimic symptoms of many common upper limb neuropathies. Approximately 10% of all peripheral nerve lesions involve some type of brachial plexus lesion. Neoplastic invasion of the brachial plexus is an uncommon, though not rare, cause of plexopathy. This article reviews the more common issues associated with physiatric treatment of patients with NBP. [1]
Lesions of the brachial plexus occur most often secondary to neoplasms that reach the plexus by direct extension (Pancoast syndrome) or, more commonly, by metastasis through lymphatics from the axilla. Pain in the shoulder, radiating down the limb, may be observed, as well as pain in the medial forearm and hand with lower trunk innervation (C8-T1 roots) in some series. The most common pathophysiology revealed on electrodiagnostic tests is axonal loss. Peripheral pain mechanisms may include lowering of the nociceptor threshold by prostaglandins and other noxious chemical substances and persistent nociceptor stimulation. Compression or infiltration of the nerves of the plexus by a tumor may produce neuralgia and inflammation.
United States
Approximately 14% of all upper limb neurologic lesions are due to brachial plexopathy of all types. Neoplastic plexopathies were responsible for 1.4 and 14.5% of symptoms in 2 series of patients who had undergone surgery. Insufficient data have been published to determine the frequency of NBP, but symptomatic NBP has been estimated to occur in 4% of patients with lung cancer and 2% of patients with breast cancer.
International
The international incidence of NBP is unknown.
In a single institution in Ireland, a 5-year retrospective study of 20 MRIs performed in patients with neoplasms, 6 (30%) confirmed a diagnosis of NBP. [2]
Primary neoplasms of the brachial plexus generally are benign, while secondary neoplasms are malignant. Most secondary tumors are metastatic, contributing to higher mortality. [3]
Solitary neoplastic lesions of the brachial plexus are more common in females. Neurofibromas demonstrate a male-to-female ratio of 1:1.
Incidence of metastatic neoplasm of the brachial plexus increases with age; thus, the condition is more common in elderly patients.
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Zinboonyahgoon N, Vlassakov K, Abrecht CR, Srinivasan S, Narang S. Brachial Plexus Block for Cancer-Related Pain: A Case Series. Pain Physician. 2015 Sep-Oct. 18 (5):E917-24. [Medline]. [Full Text].
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Mark A Wren, MD, MPH Medical Director, Department of Physical Medicine and Rehabilitation, HealthSouth Rehabilitation Hospital of Texarkana
Mark A Wren, MD, MPH is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Texas Medical Association
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists
Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Allergan<br/>Received honoraria from Allergan for speaking and teaching. for: Allergan.
Robert H Meier, III, MD Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke’s Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital
Robert H Meier, III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists
Disclosure: Nothing to disclose.
Neoplastic Brachial Plexopathy
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