Wade Jessica, Taylor Taryn
University of Ottawa, Ontario, Canada.
Carleton Sport Medicine Clinic, Ottawa, Ontario, Canada.
J Brachial Plex Peripher Nerve Inj. 2015 Jul 24;10(1):e50-e52. doi: 10.1055/s-0035-1558424. eCollection 2015 Dec.
Idiopathic brachial neuritis is a distinctive condition that occurs most often in healthy individuals. It characteristically starts with an acute unilateral shoulder pain followed by a complex of symptoms, including weakness, paresthesias, and numbness. The cause of this syndrome is unknown and difficult to diagnose in the initial phase but may occur postsurgery, postinfection, posttrauma, or postvaccination. In this case, the patient's inciting event appeared to be a cesarean section. There was no trauma to the shoulder or upper extremity by way of positioning during the procedure. Several months after denervation of the supraspinatus and infraspinatus muscles, electromyography revealed some improvement. The diagnosis was made through a combination of clinical evaluation, ultrasound, magnetic resonance imaging, and electromyography. With the exception of weakness, this patient experienced few symptoms. Treatment is symptomatic including anti-inflammatories, opiates, and neuroleptics for pain. There is some evidence that immunotherapy may help decrease the length of symptoms, but there is no strong evidence to support steroid use. Physical therapy, the foundation of therapy in this case, is a useful adjunct for rehabilitation. In general, this condition has a good prognosis for recovery, although often slow, even when there is complete denervation. This patient made a full recovery and has no lingering symptoms.
特发性臂丛神经炎是一种独特的病症，最常发生于健康个体。其典型表现为急性单侧肩部疼痛，随后出现一系列症状，包括无力、感觉异常和麻木。该综合征的病因不明，在初始阶段难以诊断，但可能发生于手术后、感染后、创伤后或接种疫苗后。在本病例中，患者的诱发事件似乎是剖宫产。手术过程中肩部或上肢未因体位摆放而受到创伤。冈上肌和冈下肌失神经支配数月后，肌电图显示有一定改善。诊断是通过临床评估、超声、磁共振成像和肌电图相结合做出的。除了无力外，该患者几乎没有其他症状。治疗以对症治疗为主，包括使用抗炎药、阿片类药物和抗精神病药物来缓解疼痛。有一些证据表明免疫疗法可能有助于缩短症状持续时间，但没有有力证据支持使用类固醇。物理治疗是本病例治疗的基础，是康复的有益辅助手段。一般来说，尽管恢复通常缓慢，即使存在完全失神经支配，这种病症的预后通常良好。该患者已完全康复，没有遗留症状。
