Paralytic brachial neuritis

　　1. Poisoning: Such as heavy metals such as lead, arsenic, mercury, and phosphorus; drugs such as isoniazid, streptomycin, phenytoin sodium, carbamazepine, vincristine, etc., as well as organic compounds such as organophosphorus pesticides.

　　2. Nutritional metabolism disorders:Such as B vitamin deficiency, diabetes, uremia, chronic severe gastrointestinal diseases, pregnancy, etc.

　　3. Infection:It often occurs with or follows various acute and chronic infections, such as dysentery, tuberculosis, infectious hepatitis, typhoid fever, mumps, etc. Some may be caused by direct invasion of the peripheral nerves by pathogens, such as paralytic brachial neuritis caused by leprosy.

　　4. Allergic变态反应:Such as paralytic brachial neuritis induced by serum treatment or after vaccination.

　　The disease generally has an acute onset and a good prognosis. During the acute phase of paralytic brachial neuritis, complications such as limb paralysis, occasional segmental or conduction bundle-type sensory disturbances, and cardiovascular dysfunction such as unstable blood pressure, tachycardia, and abnormal electrocardiograms may occur in some patients. These symptoms can be improved after treatment. Additionally, after the disease is cured, neuralgia may persist for 1-3 months, mainly manifested as intermittent numbness and pricking sensation.

　　1. Medical history and symptoms:This condition is more common in adults and often occurs after exposure to cold, a cold, or surgery. It presents with acute or subacute onset, with numbness, pain, weakness, muscle atrophy, with proximal symptoms being more severe and distal symptoms being less severe. It can affect one side (in a few cases, both sides) of the neck, scapula, or upper limb muscles.

　　2. Physical examination findings:Obvious tenderness is present at the brachial plexus trunk (above and below the clavicle or axilla) and other locations. Pain is induced by traction of the upper limb of the brachial plexus, with abduction or elevation. There is a decrease in sensation in the shoulder, lateral aspect of the upper arm, and radial side of the forearm. The reflexes of the biceps brachii and triceps brachii tendons are weakened or absent.

　　The etiology of this disease is not yet clear, and prevention should be emphasized. Measures such as strengthening labor protection, preventing metal and pesticide poisoning, and minimizing the use of furan drugs (if necessary, vitamin B complex drugs can be taken at the same time) should be taken. If young people show neurological symptoms and signs, they should be removed as soon as possible to improve the function of nerve nutrition and enhance physical fitness. For those who have already shown symptoms of neuritis such as muscle numbness, weakness, and tingling, it is necessary to supplement vitamin B1 and B12 for nerve nutrition treatment, avoid strenuous exercise, maintain rest, quit smoking and drinking, supplement calcium, and prevent muscle atrophy.

　　The diagnosis of brachial plexus neuritis, in addition to clinical manifestations, also requires necessary related examinations. The examinations are as follows:

      1. Cerebrospinal fluid examination: protein and cells may slightly increase.

　　2. Electromyography may show denervation changes.

　　In addition to conventional treatment, attention should also be paid to the following aspects in diet for patients with brachial plexus neuritis: diet should be light, pay attention to hygiene, and rationally match the diet. Avoid eating spicy and刺激性 food.

　　Treatment can be done in the outpatient department, and the prognosis is generally good.

　　1. During the acute stage, the affected limb should rest, and the upper limb can be bent at the elbow and suspended with a wide band in front of the chest.

　　2. Local physical therapy: such as paraffin therapy, ultra-short wave, cupping, etc., are effective.

　　3. Acupuncture points: shoulder, Quchi, Waiguan, Lieque, Houxi, etc.

　　4. Adrenal cortical steroids have the effect of reducing swelling and relieving pain, and prednisone 30-40mg once/d can be taken orally.

　　5. Neurotrophic drugs: cytidine diphosphocholine 250mg once/d, vitamin B12 500ug per ml once/d, vitamin B12 120mg three times/d taken orally.

　　6. Nerve Block Therapy: 5% lidocaine 5ml is used to block the brachial plexus and cervical sympathetic ganglion via the anterior and middle scalene muscle interval approach. Dexamethasone 2.5-5mg can also be injected at the brachial plexus, twice a week, for 3-5 consecutive times.

　　7. When the pain is severe, carbamazepine 0.13 times/d can be taken orally.