Difference between revisions of "Parsonage turner"

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Revision as of 16:30, 2 August 2020

Background

  • Syndrome characterized by sudden onset, severe shoulder pain followed by weakness and sensory loss as pain resolves over the course of days to weeks
  • Also known by many other names including acute brachial neuritis, acute brachial plexitis, idiopathic brachial plexopathy, neuralgic amyotrophy
  • More common in males in the 4th decade of life
  • Can affect any part of the brachial plexus
    • Most commonly affected nerves: long thoracic nerve, suprascapular nerve, axillary nerve, musculocutaneous nerve, radial nerve
  • Up to 1/3 may have bilateral involvement2
  • Upper trunk most frequently affected3
  • May have preceding viral syndrome
  • Two forms
    • Idiopathic
    • Hereditary

Clinical Features

  • Severe shoulder girdle pain
  • Weakness, paresthesias, and sensory losses that depend on which nerves are involved
  • Muscle atrophy may develop after several weeks of neuropathy
  • Loss of reflexes
  • Scapular winging


Differential Diagnosis

Upper extremity peripheral nerve syndromes

Median Nerve Syndromes

Ulnar Nerve Syndromes

Radial Nerve Syndromes

Proximal Neuropathies

Other


Evaluation

  • Plain films if there is history of trauma
  • Consider MRI in the ED to rule out acute cervical spine pathology
  • Outpatient brachial plexus MRI/MRN
  • Outpatient EMG - should be performed at least 3 weeks after symptom onset to show findings4

Management

  • Early conservative management
    • NSAIDs, sling, physical therapy
    • Antiviral medications if etiology is viral in nature
    • Oral steroids recommended by some in early disease for pain3,4
  • Operative management considered for space occupying lesions or if no recovery is seen in 6-9 months
    • Nerve decompression, neurolysis, neurorrhaphy, nerve transplant/grafting, muscle/tendon transplant/grafting

Disposition

  • Depends on etiology - acute traumatic injuries may need urgent or emergent surgery
  • Most idiopathic cases can be discharged with neurology/orthopedics follow up
  • Full recovery can take up to 2-3 years

See Also

External Links

References

  1. Feinberg et al. Parsonage-Turner Syndrome. HSSJ. 2010;6:199-205.
  2. Misamore et al. Parsonage-Turner Syndrome (Acute Brachial Neuritis). Journal of Bone and Joint Surgery. 1996;78(9)1405-1408.
  3. Moghekar et al. Brachial Plexopathies: Etiology, Frequency, and Electrodiagnostic 4. Localization. Journal of Clinical Neuromuscular Disease. 2007;9(1):243-247.
  4. Ortiz Torres M et al. Brachial Plexitis (Parsonage Turner Syndrome, Brachial Neuropathy, Brachial Radiculitis) [Updated 2020 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK448114/