How to prevent Brachial Plexus Injury?

Symptoms and Treatment of Brachial Plexus:

The Brachial Plexus lies in the posterior triangle of the neck between the muscles scalenius anterior and scalenius medius. At the root of the neck the plexus lies behind the clavicle. The plexus itself gives off several important branches:

• Nerve to rhomboids
• Long Thoracic nerve to serratus ant.
• Pectoral nerves to pectoralis major.
• Suprascapular nerve to supraspinatus infraspinatus.

In this rare disorder the brachial plexus, subclavian artery and subclavian vein may be compressed in the neck by contiguous structures such as a cervical rib or tight fibrous band.

Symptoms

Pain in the neck and shoulder with paraesthesia in the forearm, made worse by carrying a suitcase, shopping bag, etc.

Signs

1.   Sensory loss in a T1 distribution.

2.   Wasting and weakness of thenar and occasionally interosseous muscles.

3.   Signs of vascular compression:

• Unilateral Raynaud’s phenomenon.
• Pallor of limb on elevation.
• Brittle trophic finger nails.
• Loss of radial pulse in arm on abduction and external rotation at the shoulder or on bracing the shoulders.
• Subclavian venous thrombosis may occur, especially after excessive usage of arm.

Investigation

• Coronal MRI is the definitive investigation.
• Plain radiology of the thoracic outlet may reveal a cervical rib or prolonged transverse process.
• Nerve conduction/electromyography will distinguish this from other peripheral nerve lesions.
• Arteriography or venography is occasionally necessary if there are obvious vascular problems.

Treatment

• In middle-aged people with poor posture and no evidence of abnormality on plain radiology, neck and postural exercises are helpful.
• In younger patients with clinical and electrophysiological changes supporting the radiological abnormalities, exploration and removal of a fibrous band or rib may afford relief.

Brachial plexus injuries are common in sport activities, but they frequently result from auto or slip and fall injuries or drops. Braner Pain Clinics specialize in chronic pain management, neurology, neurological testing and disability. Call now for best treatment: 1 (877) 573-1282

http://www.branerpainclinic.com

How do you treat patients with Muscle Pain (Myalgia)?

Investigations And Types of Myalgia:

Muscle pain is a common medical complaint. There are many causes and clinical evaluation and appropriate investigation is often difficult. The physiological mechanisms producing such a symptom are limited.

• Mechanical Pain: results from excessive muscle tension or contraction and is cramp like.
• Inflammatory Pain: results from disruption of muscle fibres, inflammatory exudates and fibre swelling.
• Ischaemic Pain: results from metabolic change, usually in response to exercise and is deep and aching.

Muscle pain may be physiological – as a consequence of extreme exercise or pathological – as a consequence of muscle, soft tissue or systemic illness.

DIAGNOSTIC APPROACH TO MUSCLE PAIN

History:

Is muscle pain

Present at rest

• Polymyalgia rheumatica
• Fibromyalgia
• Parkinson’s disease
• Collagen vascular disease

Present with exercise

• Physiological
• Metabolic myopathies
• Benign myalgic encephalomyelitis  (ME)

Localized

• Muscle haematoma, abscess, tumors or fibromyalgia

Generalized

• Polymyalgia rheumatica
• Parkinson’s disease
• Metabolic myopathies
• Inflammatory myopathies
• Benign myalgic encephalomyelitis (ME)

Family History

• Metabolic myopathies

Exposure to toxins

• Drug induced myopathies
• Alcoholic myopathy

Examination:

Is There

Wasting/Weakness

• Inflammatory myopathies
• Metabolic myoparhies
• Drug induced myopathies
• Alcoholic myopathy

Skin Rash

• Inflammatory myopathy (dermatomyositis)
• Collagen vascular disease

Stiffness or Spasms

• Tetanus
• Tetany
• Spasticity
• Neuroleptic malignant syndrome
• Malignant hyperthermia

Muscle Swelling

• Muscle abscess, tumors
• Metabolic myopathy

INVESTIGATIONS OF MUSCLE PAIN

1 Serum Creatine Kinase (muscle enzyme)

• Elevated in muscle necrosis, high levels result in myoglobinuria.

2. Imaging (occasionally used)

• Ultrasound, MR or CT in suspected muscle haematoma, abscess or tumors.
• Radionuclide (Gallium or in suspected muscle abscess, Technetium)

3. Electromyography (EMG)

• Will confirm presence of myopathy (rarely more specific)

4. Muscle Biopsy (needle or open)

• Inflammatory myopathies metabolic myopathies
• Helpful in collagen vascular disease

5. Ischaemic Lactate Test

• Measurement of post exercise changes in serum lactate
• Reduced response in-metabolic

Following extensive investigation, in a significant number of cases no cause of myalgia is found.

TYPES OF MUSCLE PAIN:

Most disorders are covered in relevant sections. Those that are not are briefly described.

1. Fibromyalgia

A common condition of uncertain pathology in which generalized muscle pain with localized tender areas occurs without objective clinical or laboratory abnormalities. Psychiatric symptoms commonly co-exist.

2. Malignant Hyperpyrexia

Characterized by a sudden rise in body temperature whilst undergoing general anesthesia usually with halothane or succinylcholine. Certain hereditary myopathic disorders e.g. myotonic dystrophy central core disease – are unduly prone to this condition.

3. Muscle Abscess

Commonly Staphylococcal due to local trauma or blood-borne in debilitated persons.

4. Polymyalgia Rheumatica

Proximal muscle pain encountered in the elderly and often associated with giant cell arteritis. The ESR is elevated and the EMG is normal. Muscle biopsy shows type 2 fibre losses. Steroids are effective.

5. Muscle Tumors

These are rare Mixed pathological and of varying degrees of malignancy.

6. Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)

An idiopathic disorder that may follow viral illness is often associated with exercise induced muscle pain and associated with fatigue. No clear underlying pathology has been found and diagnosis is based on symptoms and exclusion of other pathology. May respond to graded exercise, tricyclic antidepressants or cognitive behavioral therapy.

Muscle pain is your body’s way of telling you about a problem. See your doctor if your myalgia is prolonged and persistent or if it is accompanied by other symptoms.Talk to your doctor about muscle relaxants to that may help ease your muscle pain.Call Us Immediately if you have: 1 (877) 573-1282.

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