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Radiation-Induced Brachial Plexopathy

Radiation-Induced Brachial Plexopathy (RIBP) may affect the shoulder, arm and hand. Symptoms can include pain, numbness, tingling and weakness. Sometimes it is associated with lymphedema. RIBP is caused by radiation treatment and often presents years after treatment. Although there is no cure for RIBP, rehabilitation measures can help people to function better by reducing discomfort and disability.

Questions to Ask Your Doctor

  1. Do I need any further testing?
  2. Will cancer rehabilitation help me feel better and/or recover faster?
  3. Are there any medications or other treatments that you recommend?

How to Protect Your Arm

Maintain your upper extremity range of motion as much as possible.
RIBP can result in limited motion and even development of contractures in your arm (often referred to as a “frozen shoulder”). When this happens, it becomes more difficult to use your arm for normal activities. Your doctor or physical/occupational therapist can give you specific range of motion (ROM) exercises to help maintain or improve the motion at the joints that have limitations.

Avoid activities that increase pain, especially if the pain last more than a few minutes.
During your daily activities, you will probably find that some things cause pain more than others. If possible, try and avoid activities that cause pain, particularly if the pain lasts more than a few minutes. This is also true of any exercises that you do. When you stretch, you may feel some uncomfortable pulling or tightness, which is normal. But the discomfort should stop within a few minutes of completing the exercises. If you have an increase in pain that lasts for a long time (more than 20 minutes) after completing your exercises, let your healthcare team know. Sometimes a physical or occupational therapist will recommend using modalities, such as heat (e.g., a “hot pack”) and/or cold (e.g., an “ice pack”) in conjunction with your ROM exercise program. When used properly, these can help promote stretching, as well as reduce pain and inflammation.

Improve your sleep.
RIBP may be keeping you awake at night. If so, ask your doctor about the possibility of medications to reduce pain and promote a good night’s rest. Sometimes sleeping positions may help. Keeping your shoulder and arm in a good position at night is important to protect your shoulder and to decrease pain. It can also help to reduce swelling. Supporting your arm on pillows is one option. If you sleep on your back, try supporting your arm with a pillow placed across your abdomen. If you sleep on your side, you can “hug” a pillow between your arms.

Reduce the stress on your arm at home.
There are many ways to make things easier around the house and for leisure activities. Here are some examples:

  • Use tools that are easy to hold. Large, non-slip handles will be easier to use (e.g., large-handled knives; large handled utensils and cooking equipment, etc.)
  • Substitute electric appliances for manual ones whenever possible. For example, an electric rather than manual can opener.
  • Try non-skid liners/mats on counters and tables to steady plates or bowls when cooking or eating. These can also aide you in opening jars.
  • Use voice-activated software for computer use or a one-handed key pad.
  • Explore voice activated “smart phones” for making calls, and using the Internet. Use a hands-free device as well.
  • Avoid holding heavy books and instead try an electronic book reader or use a book stand/holder.
  • Purchase smaller grocery and household items in order to avoid having to use both hands to carry things.
  • Use assistive devices such as zipper pulls, dressing sticks, and button hooks which can make dressing easier.
  • Velcro straps and elastic laces help make putting on and taking shoes off easier.

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