CLINICAL MANIFESTATIONS OF

BRACHIAL NEURALGIA
Rascanu Constantin Alexandru
• Brachial neuralgia is a rare disorder affecting the
brachial plexus, characterized by severe, burning
pain in the shoulder and upper arm that awakens
the patient from sleep, accompanied with
pronounced upper arm weakness. Diagnosis is
essentially clinical and may be confused with
other neck and upper extremity abnormalities
such as cervical spondylosis and cervical
radiculopathy. Correct diagnosis and timely
treatment with corticosteroids are crucial for a
favorable course of disease.
• Brachial neuralgia may involve any muscle or
any region innervated by the brachial plexus, in
any way and combination of symptoms,
indicating involvement of multifocal lesions.

• On the pain scale from 1-10 patients usu-ally

rate this pain 7 or higher.

• The pain lasts on average 27 days.

• The flexion-adduction sign (Waxman) is
usual-ly considered typical ,with the patient’s
shoulder and arm adducted and the elbow
flexed . Reflexes are frequently reduced in BN.
• The acute phase of the disease lasts from 3 to 4
weeks. In the chronic disease that may last for
months and even years, the patient usually
experiences only weakness without pain and has
findings that include local atrophy and dislocation
of the scapula.

• Similar to motor symptoms that express

multifocality and dispersion, sensory symptoms
also have this type of distribution.In patients with
only pain and sensory symptoms, complaints are
most commonly seen in the distribution of the
lateral cutaneous nerve in the elbow area.
• One of the most common locations of
sensory symptoms is the area of the deltoid
muscle and the lateral arm, with the patients
usually reporting a ‘loss of sensation in the
shoulder’.

• The main causes of brachial plexus palsies are

traction, due to extreme movements, and
heavy impact. Brachial plexus injury can occur
in a variety of ways and can occur as a result of
shoulder trauma, tumours, or inflammation.
Musculocutaneous nerve
Axillary nerve
Median nerve
Radial nerve
Ulnar nerve
 Kinetotherapeutic treatment
• Start doing a passive shoulder exercise known as
a pendulum swing. Stand upright alongside a firm
chair and gently bend your knees. Hold onto the
chair for support purposes with your uninjured
hand. Gently bend from the waist and let your
injured arm hang freely to stretch your muscles.
Slowly move your upper body to start your arm
moving like a pendulum. Swing your arm in five
clockwise circles. Stop and relax 20 seconds.
Repeat the exercise in a counterclockwise
direction.
• Isometric exercises for treatment of brachial
neuralgia provide a gentle way to increase
muscle strength. Start doing some wall-based
shoulder extensions by standing with your
back against a wall. Place your injured arm
onto the wall, palm open and flat against the
wall. Gently push your hand into the wall.
• You can start increasing your shoulder area
range of motion by doing some active
stretching maneuvers. Begin by standing
upright or sitting in a firm chair. Slowly lift
your injured arm toward the ceiling. Hold
position 10 seconds. Slowly return to original
position.
• Exercises for treatment of brachial neuralgia
must concentrate on returning range of
motion to your neck area. Accomplish this
goal by doing some neck rotation maneuvers.
Sit upright in a firm chair. Slowly turn your
head to the right without turning your back.
Hold the position for 10 seconds.
• Sit upright in a firm chair next to a waist-high
table. Keep your shoulder blades together.
Gently place your injured arm onto a table
while bending your elbow to a 90-degree
angle. Slowly move your forearm away from
you while keeping your elbow at your side.