Parsonage-Turner Syndrome

Original Editors - Jesse Demeester

Top Contributors - Jesse Demeester, Lennert De Henau, Evan Thomas, Kim Jackson, Claudia Karina, Admin, Selena Horner, WikiSysop, Wendy Walker and Adam Vallely Farrell   </div>

Definition/Description

Parsonage–Turner syndrome (PTS) is the term used to describe a neuritis involving the brachial plexus. It may present with symptoms of an isolated peripheral nerve lesion, although the pathology is thought to lie more proximally. PTS generally involves one upper limb, mostly the axillary nerve, the upper trunk of the brachial plexus, the suprascapular nerve and the long thoracic nerve are affected.

Clinically Relevant Anatomy

The brachial plexus is a network of nerve fibers. The fibers are running from the spine and are formed by the ventral rami of the lower four cervical (C5-C8) and first thoracic roots (T1). Afterwards it proceeds through the neck, the axilla and into the arm. The brachial plexus innervates the upper arm (brachium), forearm (antebrachium) and hand.6

Epidemiology /Etiology

The incidence of neuralgic amyotrophy is approximately 2 to 3 per 100,000 persons per year. The
distribution of disease shows a predominance of men over women (approximately 3:2), with the highest incidence occurring between the third and seventh decades.3 Parsonage – Turner Syndrome occurs with an overall reported incidence of 1.64 cases per 100.000 people. There does not appear to be a prevalence for hand dominance nor is there a general trend towards development of the condition more on the left versus the right.4 The etiology of the syndrome is unclear. It is reported in various clinical situations including postoperatively, postinfectious, posttraumatic and postvaccination. So the precise cause remains unknown.5

Characteristics/Clinical Presentation

Initially a sudden constant, severe shoulder girdle pain develops, This pain may extend to the trapezius ridge, upper arm, forearm, and hand. The pain is not positional and usually worse at night and may be associated with awakenings from sleep. The pain is often described as a severe ache or throbbing radiating from the shoulder distally down the arm or proximally into the neck. The duration of pain is almost always self-limiting, lasting 1 to 2 weeks but on rare occasions can persist for longer periods of time.4,6
Other symptoms are:
- Sensory deficits (not in all the patients)
- Muscle weakness
- Muscle-atrophy (within a month)

Scapular winging may be seen when there is involvement of the scapulothoracic nerve innervating the serratus anterior muscle. The weakness may be limited to muscles innervated by a single peripheral nerve or any combination of peripheral nerves or the brachial plexus.
On EMG study a widespread denervation is seen of the affected muscles.
MRI may show a nonspecific inflammatory response in the brachial plexus in case of PTS.

Differential Diagnosis

At the onset, the pain is situated around the shoulder girdle and this can look like numerous shoulder problems. Like rotator cuff tears ⁴, adhesive capsulitis, calcific tendonitis, arthritis. When the muscle weakness kicks in other conditions can have the same symptoms. Discogenic nerve root compression ⁴, tumors of the spinal cord, thoracic outlet syndrome, cervical artery dissection.⁵

Diagnostic Procedures

The characteristic pattern of pain followed by profound weakness are generally the clues to the diagnosis of Parsonage– Turner syndrome^1,2,3,4 with confirmation being sought by electromyography. This pain is often described as a severe ache or throbbing radiating from the shoulder distally down the arm or proximally into the neck

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