Paralysis refers to a temporary or permanent loss or impairment of motor or sensory function in a part. The upper radicular group refers to the IVth, Vth and VIth cervical nerves, which are pairs of nerves extending from the spinal cord with distribution to the shoulder, scapular and back muscles. They consist of motor and sensory roots and pathways. This upper group is one of three trunks forming the brachial plexus (C5 and C6).

Paralysis of these nerves may be caused by damage to the nerve fibers, cell body, or myelin sheath. Causes of the damage may include: trauma; penetrating missile injury; shoulder injury; overextension of a joint; brachial neuritis; carrying heavy objects supported at the shoulder; iatrogenic injection injuries; metabolic injury; infection; compression of the nerve from degenerative bone changes; nerve entrapment; fractures; irradiation; or tumors.

Manifestations of the condition may include: partial sensory loss to the outer arm and forearm; inability to raise the arm at the shoulder; decreased reflexes; pain; moderate to severe muscle weakness; muscle atrophy; and edema of the injured limb. In addition, there may be paralysis of forearm flexion, of abduction, and of internal rotation and external rotation of the arm. Distal paresthesias and pain; complete paralysis, and inability to use a normal functioning hand may also be evident. Other signs and symptoms may be present depending on the involvement of neighboring nerves.

Diagnostic measures may include: a complete history; physical and neurological examinations; motor, sensory and reflex tests; blood studies; spinal tap; evoked responses; electromyography (EMG); x-ray; computed tomography (CT) scan; and magnetic resonance imaging (MRI).

Treatments may include management of the underlying disorder. Measures for treatment may include: wrist splints; passive range of motion (ROM) exercises; anti-inflammatory or pain medications; transcutaneous electrical nerve stimulation (TENS); or, in some cases, surgery may be needed.

Regeneration may depend on the degree of axonal injury and site of injury. The closer the injury is to the central nervous system (CNS), regeneration of a severely damaged nerve is less likely to occur. Recovery may range from complete function to permanent dysfunction. There may be severe limitations in shoulder and elbow joint mobility from lack of use, and a potential for contractures to develop. In compression injury, complete recovery may take weeks depending on the length and severity of compression. Intensive rehabilitation may be delayed for certain injuries. Alteration of employment and daily activities may require counseling intervention.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a). [chronic disease].

• If the Veteran was exposed to an herbicide agent during active military, naval, or air service, this disease shall be service-connected if the requirements of 38 CFR 3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 CFR 3.309(e). Disease subject to presumptive service connection

• Consider potential entitlement to special monthly compensation for loss of use of hand or foot when assigning the higher evaluations under particular Diagnostic Codes (e.g., Diagnostic Code 8510 through 8515, 8520, and 8521).

 Notes

• None.