Lyme Disease Brachial Plexopathy: Arm Weakness and Nerve Pain
Brachial plexopathy may occur in Lyme neuroborreliosis.
Arm weakness, radicular pain, and meningitis can overlap.
Tick exposure may go unrecognized.
Lyme disease brachial plexopathy is an uncommon neurologic presentation that may initially resemble cervical radiculopathy, peripheral neuropathy, or other nerve disorders.
In one published case, a 76-year-old man developed progressive arm weakness, neck pain, shock-like nerve pain, and meningitis due to early Lyme neuroborreliosis. [1]
The case highlights how Lyme disease may present with painful neurologic symptoms even when no known tick bite is recalled.
What Is Brachial Plexopathy?
Brachial plexopathy is a form of peripheral neuropathy involving damage or inflammation of the brachial plexus, a network of nerves extending from the lower neck into the shoulder and arm. [2]
Symptoms may include:
- Arm weakness
- Neck or shoulder pain
- Numbness or tingling
- Burning or shock-like pain
- Reduced grip strength
Because these symptoms overlap with orthopedic and neurologic conditions, Lyme disease may not be recognized initially.
Initial Symptoms Resembled Cellulitis
Gu and colleagues described the case in their article “Early Lyme neuroborreliosis manifesting as brachial plexopathy and meningitis in Northwestern Ontario, Canada.” [1]
The patient initially presented with:
- Left arm weakness
- Neck pain
- Headaches
- Body aches
He also reported a presumed mosquito bite that became red and swollen.
Doctors diagnosed purulent cellulitis and prescribed a 7-day course of cephalexin.
His symptoms initially improved.
Neurologic Symptoms Progressed Weeks Later
Twenty-four days later, the patient returned with worsening symptoms.
He complained of:
- Mild headaches
- Shock-like pains radiating into the arms and chest
- Progressive left arm weakness
- Neck pain
- Night sweats
Over several emergency department visits, his neurologic symptoms continued to worsen.
Imaging Suggested Polyradiculitis
MRI findings demonstrated increased signal uptake along the spinal cord and left brachial plexus, findings considered consistent with polyradiculitis. [1]
Lyme disease testing later returned positive by both ELISA and Western blot.
The authors concluded:
“The patient was diagnosed with meningoradiculitis as a manifestation of early Lyme neuroborreliosis.” [1]
IV Ceftriaxone Led to Gradual Recovery
The patient began treatment with intravenous ceftriaxone.
Over the following year, he experienced gradual improvement in muscle strength and sensation, although neck and arm pain resolved more slowly. [1]
The prolonged recovery illustrates how neurologic Lyme disease symptoms may persist even after treatment begins.
Why Lyme Neuroborreliosis Is Sometimes Missed
The authors emphasized that patients may not remember a tick bite or recognize an erythema migrans rash.
As a result, clinicians may initially pursue other explanations such as:
- Cervical radiculopathy
- Peripheral neuropathy
- Cellulitis
- Orthopedic shoulder disorders
- Meningitis from other causes
Neurologic Lyme disease may be particularly difficult to diagnose when symptoms fluctuate or evolve gradually.
The authors concluded:
“Patients with new cranial neuropathy, painful radiculitis, or aseptic meningitis who present in a Lyme endemic area during or shortly after tick season should be alert to the possibility of early Lyme neuroborreliosis.” [1]
Learn more about neurologic Lyme disease, Lyme disease misdiagnosis, Lyme meningitis, and Lyme coinfections.
Frequently Asked Questions
Can Lyme disease cause arm weakness?
Yes. Lyme neuroborreliosis may affect peripheral nerves, spinal roots, or the brachial plexus, leading to weakness or sensory symptoms.
What is brachial plexopathy?
Brachial plexopathy refers to damage or inflammation affecting the nerve network that controls the shoulder, arm, and hand.
Can Lyme disease mimic cervical radiculopathy?
Yes. Lyme radiculitis and brachial plexopathy may resemble cervical spine disease or nerve compression disorders.
Can Lyme meningitis occur without a known tick bite?
Yes. Some patients with Lyme neuroborreliosis never recall a tick attachment or classic erythema migrans rash.
How is neurologic Lyme disease treated?
Treatment often involves antibiotics such as intravenous ceftriaxone, particularly in cases involving meningitis or significant neurologic involvement.
Clinical Takeaway
Lyme disease brachial plexopathy is an uncommon but important neurologic presentation that may cause arm weakness, severe nerve pain, meningitis, or radicular symptoms.
Because patients may not recall a tick bite or rash, diagnosis is often delayed while other neurologic or orthopedic conditions are considered first.
Clinicians should consider Lyme neuroborreliosis in patients with painful radiculitis, progressive weakness, or meningitis symptoms in endemic regions.
Related Articles
Lyme Meningitis Leading to Hyponatremia
Podcast: Meningitis and Radiculitis Due to Lyme Disease
Neck Pain in a Child With Lyme Radiculoneuritis
Neurologic Lyme Disease
Lyme Disease Misdiagnosis
References
- Gu K, Boodman C, Orr P, Wuerz T. Early Lyme neuroborreliosis manifesting as brachial plexopathy and meningitis in Northwestern Ontario, Canada: A case report. Medicine (Baltimore). 2022;101(45):e31576.
- Mount Sinai. Brachial plexopathy.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
