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Plexopathies: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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Brachial and lumbosacral plexopathies result in painful sensorimotor damage to the corresponding limb.
Since the plexus is formed by several nerve roots, the symptoms do not correspond to the distribution of individual roots and nerves. In case of disorders of the rostral part of the brachial plexus, the proximal parts of the arms are affected, in case of the caudal part of the brachial plexus - the hands and forearms, and in case of the lumbosacral part - the legs.
[ Causes of plexopathies
Plexus lesions (plexopathies) are usually caused by compression or trauma. Plexopathy in infants may result from traction during birth. In adults, the usual cause is trauma (for the brachial plexus, this is a fall that causes forces that bend the neck away from the plexus being injured) or invasion by metastatic cancer (for the brachial plexus, this is usually breast or lung cancer; for the lumbosacral plexus, this is genitourinary or intestinal tumors). In patients taking anticoagulants, a hematoma may compress the lumbosacral plexus. Neurofibromatosis sometimes affects the plexus . Other causes include fibrosis after radiation therapy (eg, in breast cancer) and diabetes.
Acute brachial neuritis ( neuralgic amyotrophy) occurs mainly in men, especially in young people, although it can occur at any age. The cause of plexopathies is unknown, but viruses and immunological factors of inflammation are believed to be involved.
Symptoms of plexopathies
Symptoms of plexopathies are as follows: pain in the limb and motor or sensory dysfunction that do not correspond to the innervation zone of a separate nerve root. In acute brachial plexitis, complaints include severe pain in the supraclavicular region, weakness and decreased reflexes with minor sensory disturbances in the innervation zone of the brachial plexus. Weakness and decreased reflexes appear after the pain subsides. Severe weakness develops within 3-10 days, then it decreases over several months. Most often, the muscles innervated by the upper trunk of the brachial plexus (anterior serratus and others) are affected, as well as the muscles innervated by the anterior interosseous nerve of the forearm.
Diagnosis of plexopathies
The diagnosis of plexopathies is made based on the clinical picture. To determine the anatomical localization (including possible damage to the nerve root), EMG should be performed and somatosensory evoked potentials should be examined. In case of non-traumatic plexopathies, MRI of the corresponding plexus is indicated.
Treatment of plexopathies
Treatment of plexopathies is aimed at eliminating the cause. Glucocorticoids are usually prescribed, but there is no evidence of their effectiveness. In case of injuries, hematomas, benign and metastatic tumors, surgical intervention may be indicated. In case of metastases, radiation therapy, chemotherapy or a combination of both are prescribed. In case of diabetic plexopathy, glucose control is important.