Brachial Plexopathies: Update on Treatment

Purpose of review: Brachial plexopathies (BPs) are a heterogeneous group of diseases which can profoundly affect person’s function and quality of life. This review targets current approaches to treatment of different BP types. Recent findings: Although there are multiple BP etiologies, non-traumatic causes are particularly unrecognized by clinicians, leading to misdiagnoses and delay in appropriate therapies. Recent data suggests that idiopathic neuralgic amyotrophy may be 50-fold more common than previously thought, with poorer outcomes than reported unless rapid diagnosis is followed by a multidisciplinary approach to treatment, including surgery for refractory cases. Advances in diagnostic imaging reduce time to treatment, if proper recognition by primary providers leads to rapid referral to neurologists. Due to rarity, heterogeneity, and overlap of different BP syndromes, development of treatment strategies is still based on case series and retrospective studies. Despite advances in surgical therapies, there are no randomized trials to guide optimal approaches to treatment in either traumatic or non-traumatic cases. Summary: Recent advances in imaging and surgical therapies may significantly improve clinical outcomes for patients with BPs, if rapid diagnosis of these often under-recognized conditions can be substantially improved to optimize approach to management. Controlled trials are still needed to optimize therapeutic strategies.