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Musculoskeletal and Sports Medicine

Silent Damage: Recognizing a Delayed Radiation Injury

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 2

    Poster Presenter(s)

  • Aaron Wilson, MD

    Resident Physician
    Stony Brook Medicine/University Hospital PM&R Program
    Commack, New York

    • Co-Author(s)

  • ER

    Etienne Rossert, MD

    Resident physician
    Stony Brook Medicine/University Hospital PM&R Program
    Mineola, New York

  • RG

    Rahul Gunasekera, DO

    Resident
    Stony Brook Medicine/University Hospital PM&R Program
    Port Jefferson, New York

Disclosure(s):
Aaron Wilson, MD: No financial relationships to disclose
Case Diagnosis: Brachial plexopathy status post radiation treatment for tonsillar cancer.

Case Description or Program Description: 79 year old male with a history of tonsillar carcinoma status post radiation therapy 12 years ago, presented with right-sided neck pain, right upper extremity paresthesias, and right upper extremity weakness for approximately 2 years. Nerve conduction study and electromyography (EMG) was recommended due to his symptoms and past medical history.

Setting: Outpatient clinic

Assessment/Results: Manual muscle testing revealed 4/5 strength in right shoulder abduction, elbow extension, and elbow flexion; otherwise 5/5 throughout. EMG testing suggested a chronic, right upper trunk brachial plexopathy, with the presence of myokymia in the infraspinatus and deltoid.

Discussion (relevance): The brachial plexus is a network of nerves in the neck and shoulder region that supplies the upper extremities with sensory, motor, and autonomic innervation. Brachial plexopathy is a condition that occurs when the brachial plexus is damaged, with a reported incidence of 3/100,000. Symptoms may present as numbness, tingling, pain, and/or motor weakness. In this case, the presence of myokymic discharges points towards a diagnosis of radiation-induced brachial plexopathy (RIBP). Myokymic discharges are brief, spontaneous contractions of individual muscle fibers, producing a unique “marching soldier” sound on EMG testing.

Conclusions: RIBP can be grouped into transient and chronic. Chronic RIBP, as seen in this case, is thought to be a result of long-term neuronal inflammation, presenting anywhere from 1 to 20 years post-radiation. Transient RIBP is thought to be a result of schwann cell demyelination and neuronal edema post-radiation, with pain and/or paresthesias presenting within months of radiation, usually resolving on its own. A key distinguishing factor amongst the two subtypes of RIBP is the presence of myokymic discharges on EMG testing in chronic RIBP. Currently there is no known cure for chronic RIBP, though improvements in the delivery and strength of radiation may decrease the incidence of this condition.