Parsonage-Turner Syndrome: Case Study
Original Editor - Selena Horner
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Introduction[edit | edit source]
This will be the first case report to highlight clinical thinking and rationale combined with the progression and results of physical therapy treatment for a 13 year old with Parsonage-Turner Syndrome.
A 13-year-old African-American male initiated physical therapy services after a referral from an orthopaedic surgeon due to right shoulder instability. Upon subsequent physical examination by a physical therapist, the combination of significant strength deficits, substantial atrophy and no pain complaints led to further questioning. The young patient reported severe right shoulder pain approximately 4 weeks prior to the visit and contributed the symptoms to attempting to perform a push up in gym class. Upon further questioning, his parent reported an upper respiratory infection and severe neck pain approximately 4 weeks prior to the push up incident. Neither the current presentation nor the reported history were consistent with typical shoulder instability. The physical therapist recommended a referral to a physiatrist for further diagnostic testing. Electromyography and nerve conduction studies indicated neuralgic amyotrophy.
Keywords: Neuralgic Amyotrophy, Brachial Plexus Neuropathy, Parsonage-Turner Syndrome
Neuralgic amytrophy (NA), also known as Parsonage-Turner Syndrome or brachial plexus neuropathy, is quite rare with an annual incidence rate from 1 to 3 cases per 100,000 population.1,2 Onset age is usually in the 2nd or 3rd decade, but can have a range from neonatal to the 7th decade.
Because of the typical presentation, most patients with NA are initially diagnosed with a shoulder type pathology or cervical radiculopathy. Patients with NA generally seek services from their primary care physician. Due to the initial presentation, it is highly likely patients with NA are then referred to physical therapists or at times to neurologists and/or orthopedic surgeons.3
Although patients with NA are referred to physical therapists, literature is substantially lacking in what physical therapy interventions are beneficial. The majority of literature focuses on diagnosis and etiology. [references] Lack of anticipated progression is found within current published literature. This will be the first case report to highlight clinical thinking and rationale combined with the progression and results of physical therapy treatment.
Background[edit | edit source]
A 13-year-old right-handed African-American reported injuring his right shoulder while doing a push up in gym class. At that time he had substantial pain and for a couple of days was unable to use his right upper extremity. When his parent observed he wasn't using his right upper extremity normally, she sought the services of the primary care physician. Based on the reported mechanism of injury and the amount of laxity, the patient was referred for an orthopaedic consult. He was referred to physical therapy due to right shoulder laxity.
Client Characteristics[edit | edit source]
The adolescent denied pain and numbness or tingling. He reported a 50% deficit in function. The PF-10 score was 70/100.
Examination Findings[edit | edit source]
He demonstrated poor ability to elevate the right shoulder. Actively, he was only able to demonstrate approximately 140 degrees of flexion and 120 degrees of abduction. Measuring the active motion proved to be difficult due to compensatory patterns and fatigue. Multiple repetitions of assessment led to less elevation and more compensatory patterns.
Here is a video of what was observed when assessing active range of motion:
