Radiation Induced-Brachial Plexopathy and lymphedema «Lymphedema Blog

By Joachim Zuther, on the 28th January 2011

Today I would like to deal with the important and often neglected issue of radiation induced brachial plexopathy (RIBP), and how it relates to Lymphedema. This first part covers the causes and symptoms of this condition, the next blog post will discuss the treatment of RIBP with special reference to the existence Lymphedema of.

Radiation-Induced Brachial Plexopathy caused by radiation damage to Brachial plexus, a bundle of nerves near the neck and shoulder. Brachial plexus nerves that make up has its origins in the spinal cord in the neck and is responsible for sensory and muscular innervation of the entire upper extremity.

The positive effects of radiation therapy in breast cancer and other malignant diseases are well known and documented. This life-saving therapy, however, potentially adverse effects on a number of organ systems, which are exposed to the rays during treatment – such as skin, nerves, and internal organs.

In breast cancer administered radiation therapy to the breast, axillary, or neck. Radiation damage to this network of nerves can lead

Brachial Plexus

sensory or motor impairments, with or without accompanying pain in Brachial plexus distribution in the arm. Symptoms may include Paresthesia (numbness, tingling, pricking), dysesthesia (abnormal sense of touch, as burning, itching, sensation of an electric current, "pins and needles", pain), decreased sensitivity, partial loss of mobility (muscle weakness and difficulty to perform simple tasks like opening pots or containers, objects), complete arm paralysis, muscular atrophy, dexterity and partial dislocation of the shoulder joint.

The exact mechanism of RIBP is not yet fully understood. Research shows that the damage to Brachial plexus results from a combination of direct nerve cell damage from ionizing radiation and more progressive damage through the development of scar tissue (fibrosis radiation) and peripheral nerves, combined with damage to nearby vessels supplying these nerves with oxygen and nutrients. Radiation of nervous tissue causing nerve cells to shrink, which resulted in a decrease of elasticity in nerve fibers, which further exacerbates the situation. The extent of the damage associated with the radiation dose and technology and the simultaneous use of chemotherapy.

The progressive damage to vessels and the development of scar tissue continues to evolve significantly in some, and gradually in other patients [3] after the initial radiation therapy, which explains why some patients develop RIBP symptoms many years after radiation treatment. Most patients develop symptoms within the first three years. average interval between the last dose of radiation and the emergence of RIBP symptoms reported in the literature vary much (range between six months and 20 years [1, 2]). Prevalence of RIBP is reported to be between 1.8% and 4.9% [1]; RIBP is more common after radiation in combination with chemotherapy and nervous tissue of younger patients seems to be more vulnerable [4].

Relationship between RIBP and lymphedema

Persons who have had surgery and radiation for breast cancer and do not constitute even after mastectomy/lumpectomy-Lymphedema is considered in a latency stage and always runs the risk of developing lymphedema. Any additional stress to the lymphatic system, such as trauma, loss of mobility or pain may cause the appearance of the upper extremity lymphedema.

The presence of RIBP, especially in the case of wholly or partly of mobility is one of those triggering factors. Lymph tissue fluid to return from the upper extremity depends in part on the pumping action muscles exert on the outside of the lymph vessels. Stillness of these muscles in pain, paralysis, in whole or in part, has a harmful effect to the return of lymph tissue and causes the lymph fluid to stagnate in the end. In combination with the negative effects of gravity, it may trigger the emergence of lymphedema.

The people who have already RIBP and develop Lymphedema may experience an increase in pain and swelling at the partial or total loss of motor function.

Stay tuned for the next blog post that covers the treatment of RIBP with special reference to the existence Lymphedema of.Tweet

View the original article here