Function and strength declines in a client with radiation-induced brachial plexopathy: a case report.

Physiother Theory Pract

Occupational Therapist, St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada.

Published: September 2024

AI Article Synopsis

  • Radiation-induced brachial plexopathy (RIBP) is a debilitating condition that can occur after radiotherapy for cancer, and this report focuses on a 72-year-old woman with late-onset RIBP following breast cancer treatment.
  • At age 72, neurological exams revealed significant impairments in her right arm, including decreased reflexes and major drops in grip and pinch strength, indicating deterioration over time.
  • Unfortunately, there are currently no effective treatments to restore muscle strength in RIBP, and the woman's hand strength has progressively declined over three years.

Article Abstract

Introduction: Radiation-induced brachial plexopathy (RIBP) is a progressively disabling outcome of radiotherapy for a variety of cancers. This report describes measured declines over time in a client with very late RIBP, secondary to radiotherapy for breast cancer.

Case Description: After diagnosis of stage IIIA (right) breast cancer (age 50), this woman underwent bilateral mastectomy, chemotherapy and daily radiotherapy (25 sessions) to the right chest wall, supraclavicular and axillary lymph nodes. A neurological exam (age 72) showed diminished deep tendon reflexes in the right brachioradialis, biceps and triceps; nerve conduction tests revealed decreased amplitude of sensory and motor nerves in the right arm. Also, standardized measurements of grip and pinch strength were obtained by a hand therapist. The client was sent to a neurooncologist, who referred her to occupational therapists to update standardized assessments of grip/pinch strength and functional dexterity, as well as provide assistive technology and therapy suggestions.

Outcomes: Grip strength decreased 28.1%, with recent grip strength < 50% of the median normative value for the dominant hand. Lateral pinch strength dropped by 67%, now 16% of normal. Lateral key/three-point pinch strength decreased by 95%, now 2.3% of normal. Functional dexterity decreased also in the affected hand, with astereognosis noted.

Discussion: This is the first report describing increasing deficits in RIBP using standardized measures of grip and pinch strength, manual dexterity and stereognosis. Sadly, there is no successful intervention to increase muscle strength in RIBP which results in progressive strength loss, as shown with this client's hand strength over three years.

Download full-text PDF

Source
http://dx.doi.org/10.1080/09593985.2024.2409725DOI Listing

Publication Analysis

Top Keywords

radiation-induced brachial
8
brachial plexopathy
8
function strength
4
strength declines
4
declines client
4
client radiation-induced
4
plexopathy case
4
case report
4
report introduction
4
introduction radiation-induced
4

Similar Publications

Article Synopsis
  • The ataxia-telangiectasia mutated (ATM) gene plays a crucial role in cell checkpoint signaling and repairing DNA damage, particularly double-stranded breaks.
  • A 50-year-old woman with stage IIIA breast cancer had genetic testing revealing harmful mutations in the ATM gene, making her less able to handle radiation therapy.
  • Despite guidelines suggesting that radiation treatment is safe for individuals with ATM mutations, she suffered severe side effects, including brachial plexopathy, which hadn't been previously linked to these specific mutations.
View Article and Find Full Text PDF
Article Synopsis
  • Diagnosing brachial plexopathy in cancer patients is challenging due to factors like tumor recurrence, metastasis, and effects of radiation therapy, which can lead to serious misdiagnoses.
  • A case study involving a 29-year-old female with a history of nasopharyngeal carcinoma revealed that her brachial plexopathy was caused by a malignant peripheral nerve sheath tumor (MPNST) infiltrating the brachial plexus, leading to cord compression.
  • Understanding the causes of brachial plexopathy is vital for accurate diagnosis and treatment in cancer patients, as distinguishing between various potential causes can significantly improve patient outcomes and prevent complications.
View Article and Find Full Text PDF
Article Synopsis
  • - Radiation induced brachial plexopathy is a condition that develops slowly after radiotherapy, often showing symptoms like neuropathic pain, weakness, and dysfunction of the limbs.
  • - Symptoms can arise months to years later and significantly affect patients' quality of life.
  • - The review discusses the latest insights on treatment options for this condition, including surgical interventions such as neurolysis, nerve transfers, and vascularized free tissue transfer, aimed at helping hand surgeons stay informed.
View Article and Find Full Text PDF
Article Synopsis
  • The study aimed to assess the effectiveness and side effects of high-dose carbon ion radiation therapy (CIRT) in treating patients with malignant peripheral nerve sheath tumors (MPNSTs), analyzing data from 23 patients treated between 2013 and 2020.
  • Results showed promising overall survival rates of approximately 82% at 1 year and 61.5% at 2 years, alongside local relapse-free survival rates of 65% and 48.8% at the same intervals, with no treatment-related deaths reported.
  • While some patients experienced acute (43.5%) and late (34.8%) toxicities mostly classified as grade 2 or higher, there were no severe toxicities (grade 4)
View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!