Difference between revisions of "Parsonage turner"

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*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
==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]]
****[[Epstein-Barr]], [[CMV]], [[influenza]], [[parvovirus]], [[coxsackie]], [[HIV]], [[Polio]]
****[[Lyme]], [[Leptospirosis]], [[TB]], [[Salmonella]]
****[[Pancoast tumor]]
***Penetrating or blunt neck/shoulder trauma
***Traction injury
***Birth trauma
****[[Erb's palsy]]
****[[Klumpke's paralysis]]
**Connective tissue disorders
**Autoimmune disorders
***[[Polyarteritis nodosa]]
***[[Temporal arteritis]]
***Medication induced
**Hereditary Neuralgic Amyotrophy
*[[Rotator Cuff Injury]]
*[[Adhesive capsulitis]]
*[[Calcific tendinitis]]
*[[Thoracic outlet syndrome]]
===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]]
*[[Brachial plexopathy]]
*[[Cervical radiculopathy]]
*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>
*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
*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==
# 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