The 10-year-old boy had severe pain in his right arm for more than two months, which turned out to be a rare brachial plexus neuritis

Recently, the Qilu Hospital (Qingdao) Of Shandong University received a 10-year-old boy who was admitted to the hospital for "severe pain in his right arm for more than 2 months", and had previously been treated in multiple departments of many hospitals in the province, but the pain has not been alleviated. After the hospital's multidisciplinary consultation, the diagnosis was clear, and the child's pain symptoms completely disappeared after treatment, and a long-lost smile appeared on his face.

Rizhao Juxian boy Xiao Wei is 10 years old this year, 2 months before the treatment had a cold, after the right neck, right occipital pain, and gradually spread to the right shoulder back position, right arm, right palm, right hand back, right hand five fingers. Xiao Wei said that he was needle-like, knife-like, and continuous severe pain, and that he would wake up in pain when he turned over at night; his right arm was hanging in front of his chest and he did not dare to move, and his head would aggravate the pain due to activity; even coughing and speaking loudly would aggravate the pain.

After the onset of the child's illness, parents have taken their children to see many pediatrics, surgery, orthopedics, pain departments, rehabilitation departments, neurology and other departments in the province, and have been diagnosed with "cervical joint disorders", "rotator cuff syndrome", "rheumatism", etc., but the pain continues to increase. After the illness, Xiao Wei not only could not continue to go to school, but also his daily diet and sleep were seriously affected, and the pain became a big stone in his heart, which seriously affected his mental health. In more than 2 months, Xiao Wei's weight dropped by nearly 5 kg. The family is distressed but unable to do anything about it.

After the patient was admitted to the hospital, Professor Huang Qikun, director of the Department of Pediatrics of Qilu Hospital (Qingdao) of Shandong University, led the doctors of the neurology group to conduct a careful medical history inquiry and a comprehensive and systematic physical examination of Xiao Wei. The patient's cranial nerves, left upper extremity, and lower extremity movements, sensations, and tendon reflexes were found to be normal. The pain affects only the right occipital, neck, shoulder blades, and entire right upper extremity. The patient is allergic, and when he touches the skin in this area with a cotton swab, he will feel a sharp burning pain and the movement of the right upper limb is severely restricted. Professor Huang Qikun's team further analyzed and found that the area affected by the lesion was completely consistent with the area innervated by the right brachial plexus, which was consistent with the cervical spinal canal lesions that led to root damage to the right brachial plexus nerve.

So what exactly is causing right brachial plexus nerve injury? Is it a tumor? hematoma? Cervical dislocation? Herniated discs? Genetic mutations? Or is it an inflammatory lesion of the brachial plexus?

In order to further clarify the cause, the Department of Pediatric Internal Medicine invited multidisciplinary consultations such as neurology, spine surgery, and neurosurgery, and a series of examinations such as electromyography and cervical magnetic resonance imaging, and the results pointed to the diagnosis of brachial plexus neuritis.

After the cause was clarified, Professor Huang Qikun's team tailored a treatment plan for XiaoWei. After explaining and communicating with the family, the treatment was carried out according to the plan, and on the second day of treatment, the patient felt that the pain in the neck, shoulder and back was significantly reduced; on the morning of the third day, the patient's pain completely disappeared, and the right hand could use chopsticks to pick vegetables. Seeing Professor Huang Qikun's team who rounded the room, the child showed a long-lost smile on his face and excitedly thanked him: "Thank you for saving me."

What is brachial plexus neuritis? How rare is it?

Brachial plexus neuritis is a rare neurological disorder in children characterized by a history of upper respiratory tract infection, sudden severe pain on one side of the shoulder, back, and upper extremities, and pain localized in the sensory area of the distribution of the brachial plexus nerve. In the early stages of the disease, it is mainly manifested as: severe and persistent needle-like or burning pain in the shoulder and back, which is unbearable, affects life and sleep, and can induce or aggravate pain when the affected limb is exercised; if it is not properly treated for a long time, muscle weakness, atrophy, and sensory loss may occur. Brachial plexus neuritis is rare, with an incidence of 0.02‰ to 0.03‰ in adults, and is more rare in children. Due to its rarity, the clinical awareness rate of the disease is low, which is easy to cause misdiagnosis and mistreatment. (Reporting by Xiao Fang, client reporter of Dazhong Daily, correspondent Feng Ping)