516 - The Utility of a Cervical Epidural Steroid Injection for the Treatment of Idiopathic Brachial Neuritis

Case Diagnosis: Idiopathic Brachial Neuritis.

Case Description: A 40-year-old male presented with severe acute shoulder pain. Severe guarding of the joint was observed. Inspection of the shoulder joint upon flexion revealed lateral winging of the right scapula. Palpation revealed extreme tenderness to musculature of the shoulder girdle associated with severe exacerbation of pain upon movement of the shoulder joint in any plane. MRI was remarkable for intramuscular edema within the supraspinatus, infraspinatus, teres minor, subscapularis, and teres major. Cervical MRI revealed mild degenerative changes within the right neural foramen. Following initial trigger point injections, oral analgesics, and a course of oral corticosteroids with no relief the patient was treated with a cervical interlaminar epidural steroid injection (CIESI). The patient experienced immediate pain relief followed by continued improvement in symptoms over the course of the next week.

Discussions: Idiopathic brachial neuritis is an uncommon disorder that predominately effects the superior and middle trunks of the brachial plexus. Severe throbbing and aching shoulder pain is initially present for a period of days to weeks followed by severe weakness and atrophy that can develop for an extended period of months to years. There are currently no known treatments for brachial neuritis with the standard of care consisting of analgesics and corticosteroids which provide minimal benefit in most cases. In this case, a CIESI is shown to cure a case of brachial neuritis.

Conclusions: This case underscores the value of early recognition along with proper history and physical examination for the diagnosis of brachial neuritis and the utility of CIESI as a treatment option, thus preventing long term pathological sequalae. To our knowledge this is the first known reported case to have successfully treated brachial neuritis.