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Plexopathies: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Shoulder and lumbosacral pleksopatii lead to painful sensorimotor damage to the corresponding limb.
Since the plexus forms several nerve roots, the symptomatology does not correspond to the distribution of individual roots and nerves. When violations of the rostral part of the brachial plexus, the proximal parts of the hands, the caudal part of the brachial plexus - the hands and forearm, and the lumbosacral - the legs are affected.
[Causes of plexopathy
Plexus lesions usually cause compression or trauma. Plexopathy in infants can be the result of traction during labor. In adults, the common cause is trauma (for the brachial plexus this is a fall in which forces arise that bend the neck away from the traumatized plexus) or invasion of metastatic cancer (for the brachial plexus it is usually breast or lung cancer, for the spine plexus - tumors of the genitourinary system or intestines). In patients taking anticoagulants, the hematoma can squeeze the lumbosacral plexus. Sometimes the plexus affects the disease of neurofibromatosis. Other causes include fibrosis after radiation therapy (for example, in breast cancer) and diabetes.
Acute shoulder neuritis ( neuralgic amyotrophy) occurs mainly in men, especially in young people, although it is possible at any age. The cause of plexopathies is unknown, involving the involvement of viruses and immunological factors of inflammation.
Symptoms of plexopathy
Symptoms of plexopathy are the following: pain in the limbs and motor or sensory dysfunction that do not correspond to the innervation of the separate nerve root. In acute shoulder plexitis, complaints of severe pain in the supraclavicular region, weakness and decreased reflexes with slight disturbances of sensitivity in the innervation zone of the brachial plexus. Weakness and decreased reflexes appear after a reduction in pain. The expressed weakness develops within 3-10 days, then it decreases within several months. Muscles, innervated by the upper trunk of the brachial plexus (anterior dentate and others), and muscles innervated by the anterior interosseous nerve of the forearm are more often affected.
Diagnosis of plexopathy
The diagnosis of plexopathies is based on the clinical picture. To ascertain anatomical localization (including possible damage to the nerve root), EMG should be performed and somatosensory evoked potentials should be investigated. In non-traumatic plexopathies, an MRI of the corresponding plexus is shown.
Treatment of plexopathies
Treatment of plexopathies is aimed at eliminating the cause. Usually, glucocorticoids are prescribed, but there is no evidence of their effectiveness. In trauma, hematoma, benign and metastatic tumors, surgical intervention can be indicated. When metastases are prescribed radiotherapy, chemotherapy or a combination of them. With diabetic plexopathy, glucose control is important.