Difference between revisions of "Parsonage turner"

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==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 involvement<sup>2</sup>
 
*Upper trunk most frequently affected<sup>3</sup>
 
*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==
 
*[[Brachial plexopathy]]
 
**Idiopathic
 
**Post-infectious
 
***Viral
 
****[[Epstein-Barr]], [[CMV]], [[influenza]], [[parvovirus]], [[coxsackie]], [[HIV]], [[Polio]]
 
***Bacterial
 
****[[Lyme]], [[Leptospirosis]], [[TB]], [[Salmonella]]
 
**Post-immunization
 
**Compressive
 
***Neoplasm
 
****[[Pancoast tumor]]
 
**Post-traumatic
 
***Penetrating or blunt neck/shoulder trauma
 
***Traction injury
 
***Birth trauma
 
****[[Erb's palsy]]
 
****[[Klumpke's paralysis]]
 
**Connective tissue disorders
 
**Autoimmune disorders
 
***[[Lupus]]
 
***[[Polyarteritis nodosa]]
 
***[[Temporal arteritis]]
 
**Iatrogenic
 
***Post-surgical
 
***Medication induced
 
***Radiation
 
**Hereditary Neuralgic Amyotrophy
 
 
*[[Rotator Cuff Injury]]
 
*[[Adhesive capsulitis]]
 
*[[Calcific tendinitis]]
 
*[[Thoracic outlet syndrome]]
 
*[[ALS]]
 
*[[Poliomyelitis]]
 
 
===Upper extremity [[peripheral nerve syndromes]]===
 
====Median Nerve Syndromes====
 
*[[Median Mononeuropathy (Carpal Tunnel Syndrome)|Carpal tunnel syndrome]]
 
*[[Pronator teres syndrome]]
 
*[[Anterior interosseous neuropathy]]
 
 
====Ulnar Nerve Syndromes====
 
*[[Ulnar neuropathy at the elbow and wrist]]
 
 
====Radial Nerve Syndromes====
 
*[[Radial neuropathy at the spiral groove]] (ie. "Saturday night palsy")
 
*[[Posterior interosseous neuropathy]]
 
 
====Proximal Neuropathies====
 
*[[Suprascapular neuropathy]]
 
*[[Long thoracic neuropathy]]
 
*[[Axillary neuropathy]]
 
*[[Spinal accessory neuropathy]]
 
*[[Musculocutaneous neuropathy]]
 
 
====Other====
 
*[[Brachial plexopathy]]
 
*[[Cervical radiculopathy]]
 
 
 
==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 findings<sup>4</sup>
 
 
==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 pain<sup>3,4</sup>
 
*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==
 
<references/>
 
# Feinberg et al. Parsonage-Turner Syndrome. HSSJ. 2010;6:199-205.
 
# Misamore et al. Parsonage-Turner Syndrome (Acute Brachial Neuritis). Journal of Bone and Joint Surgery. 1996;78(9)1405-1408.
 
# Moghekar et al. Brachial Plexopathies: Etiology, Frequency, and Electrodiagnostic 4. Localization. Journal of Clinical Neuromuscular Disease. 2007;9(1):243-247.
 
# 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/
 

Revision as of 16:31, 2 August 2020