Shoulder: brachial plexus neoplasia Jump to... Pathogenesis Diagnosis Treatment Prevention Sequelae Sources Introduction Locally invasive. Rarely metastatic. Signs : occasional swinging limb lameness; pain on shoulder extension or axillary palpation; mass may be detectable; muscle atrophy; neurological deficits. Treatment : forequarter amputation + removal of any intradural component via laminectomy. Prognosis : very guarded. Presenting signs Mostly middle-aged individuals. Intractable lameness for several weeks/months. Weight-bearing/swinging limb lameness. Muscle atrophy varies depending on nerve roots involved. Pain on shoulder manipulation, especially extension. Pain on axillary palpation. Palpable mass. Neurological deficits. Age predisposition Middle-aged or older. Younger. Breed predisposition Medium to large breeds. Pathogenesis Top Etiology Usually primary tumors of the nerve. Occasionally secondary tumors, eg osteosarcoma, chondrosarcoma. Pathophysiology Locally invasive. May cause spinal cord compression leading to neurological signs in hindlimbs. Neurogenic atrophy of muscles may occur. Often involves nerve root as it passes out from vertebral column. Intradural/extramedullary lesions may be seen. Pulmonary metastasis rare. Timecourse (incubation, duration) Several weeks or months. Diagnosis Top Presenting problems Forelimb lameness. Client history Mostly middle-aged to older individuals. Intractable forelimb lameness. Clinical signs Weight-bearing/swinging limb lameness. Pain on joint manipulation, especially extension. Pain on axillary palpation. Obvious muscle atrophy, especially supraspinatus. Detectable mass. Neurological deficits, eg poor proprioceptive and withdrawal reflexes, ipsilateral loss of panniculus reflex, partial or complete Horner's syndrome. Neurological deficits in hindlimbs (spinal cord compression). Neck pain (vertebral column involvement). Diagnostic investigation Electrophysiology Evaluation of muscles served by brachial plexus. Surgery To explore brachial plexus +/- biopsy (craniolateral approach/laminectomy). Radiography To eliminate other differentials. Radiography: plain Enlargement of vertebral foramina (tumor involving nerve root). Myelography Intradural/extramedullary lesions. Confirmation of diagnosis Discriminatory diagnostic features Radiographic findings. Definitive diagnostic features Biopsy. Treatment Top Standard treatment Amputation Thoracic limb +/- intradural component via laminectomy if vertebral canal involvement. Radiation therapy Post-surgical  , but only if good margins achieved at excision. Subsequent management Sequelae Top Prognosis Very guarded - complete removal very difficult or impossible owing to difficulty in assessing extent of lesion on gross examination and proximity of brachial plexus tumors to spinal cord prevents adequate margins being taken. Reasons for treatment failure Incomplete excision of tumor. Back to top © Copyright Vetstream CANIS DIS00881

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