May 9, 2019 e-Pearl of the Week: Parsonage Turner syndrome
Parsonage Turner syndrome (neuralgic amyotrophy)
Parsonage Turner syndrome (PTS) typically presents as an abrupt onset of atraumatic, unilaterally constant, and severe shooting-type of shoulder pain that radiates to the hand, upper back, and neck and is succeeded by a flaccid paresis without sensory loss1. PTS is typically self-limiting with symptoms lasting up to 1-2 years followed by incomplete recovery of muscle power. Recurrence rate is 26% within 2 years of onset. Incidence ranges from 3 per 100,000 to 1 per 1,000 per year. Constitutional symptoms are atypical with PTS. The most common risk and exacerbating factors include previous history of viral infection, immunization, recent surgery, or injury to remote area.2 Differential diagnosis includes inflammatory myositis, postherpetic neuralgia, Lyme disease, diabetic and compressive neuropathies, thereby warranting specific investigations. PTS is diagnosed based on typical clinical presentation and EMG pattern showing acute denervation, axonal degeneration, and fibrillation potentials.3 Treatment involves analgesics. Passive range of motion exercise is essential to prevent adhesive capsulitis.1 Corticosteroids have mixed therapeutic efficacy1.
References
1. Van Alfen N, Van Eijk J.J.J, Ennik T, et al. Incidence of Neuralgic Amyotrophy (Parsonage Turner Syndrome) in a Primary Care Setting - A Prospective Cohort Study. PLoS ONE 2015;10: e0128361. https://doi.org/10.1371/journal.pone.0128361
2. Fibuch EE, Mertz J, Geller B. Postoperative onset of idiopathic brachial neuritis. Anesthesiology 1996;84:455–458.
3. Monterio dos Santos RB, Monterio dos Santos S, Leal FJ, et al. Parsonage-Turner syndrome. REV BRAS ORTOP 2015;50:336–341.
Submitted by Kunal Pradip Kanakia, Medical Student, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) and Faisal Khan, MD, DABNP, DABSM, Consultant Neurologist, Sugar Land Sleep and Neurology.
Kunal Pradip Kanakia and Dr. Khan report no disclosures.