Cervical Radiculopathy or Parsonage-Turner Syndrome: Differential Diagnosis of a Patient With Neck and Upper Extremity Symptoms

Abstract

3Study Design: Resident's case problem. Background: The signs and symptoms of cervical radiculopathy (CR) warrant the consideration of several other conditions in CR's differential diagnosis. One condition that may mimic CR, which is not well known amongst physical therapists, is Parsonage-Turner syndrome (PTS). PTS is characterized by an onset of intense pain that typically subsides within days to weeks. However, as pain subsides, weakness and/or paralysis may develop in upper extremity muscles. The purpose of this resident's case problem is to describe a patient who presented to our clinic with a diagnosis of CR, but had findings consistent with PTS. Diagnosis: The patient was a 43-year-old male referred to physical therapy with a diagnosis of CR. He had a previous episode of CR 1 year ago that was treated successfully. He had positive magnetic resonance imaging findings of structural abnormalities suggestive of causative factors for CR. The patient was treated for CR with thoracic and cervical spine manipulations and intermittent cervical traction. The initial acute severe pain subsided, but weakness in the upper extremity worsened. Diagnosis of PTS was made upon exclusion of other potential confounding diagnoses and the findings of fibrillation potentials and positive waves in electrodiagnostic studies. Discussion: CR and PTS are characterized by pain in the cervical spine, shoulder, and upper extremity. CR generally has an insidious onset, while PTS has a rapid onset of intense pain. Symptoms of CR are exacerbated with neck movements, while symptoms related to PTS should not be exacerbated with neck movements. In patients that do not respond to conventional therapy and have a progression of upper extremity muscle weakness, regardless of decreased pain, the diagnosis of PTS should be considered. J Orthop Sports Phys Ther 2005;35:659-664.

Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain

“…In case of cervical pathology, the symptoms may worsen in certain positions (e.g., turning the neck to the affected side worsens symptoms because it causes more compression on the nerve root by decreasing the volume of the neural foramen) [5,20]. On physical examination, the Spurling's maneuver may be positive because it decreases the volume of the neural foramen and transiently increases compression on the affected nerve root [5,9,21]. The Elvey ''brachial plexus tension test'' can be useful, too; in fact, this is able to discriminate referred and local sources of upper limb pain [22].…”

“…The differential diagnosis between shoulder pain originating from cervical spine or from shoulder structures has been widely discussed in the literature [4,5,14,15]. In the Bone and Joint Decade 2000-2010 Task Force on neck pain and its associated disorders [16], it emerges that the clinical routine physical examination is more effective in ruling out cervical radiculopathy than confirming its presence.…”

“…In addition, it is challenging to get to a correct diagnosis because the two conditions are often concomitant during the middle and advanced age [4,5] and because they share common innervation patterns along with overlapping musculature. To our knowledge, there is no note in the literature about a specific clinical test that could help the surgeon in the differential diagnosis between cervical spine and shoulder pathologies.…”

Síndrome de Parsonage-Turner en infancia y adolescencia. Caso clínico

“…Los objetivos terapéuticos son reducir el dolor, prevenir la restricción de la movilidad y recuperar la fuerza muscular. 12 En las fases iniciales se ha recomendado tratamiento con corticoides e inmunoglobulinas, basándose en la hipótesis neuroalérgica del sín-drome, 13 con el objeto de prevenir la debilidad muscular, pero la eficacia de estas medidas no ha sido probada. Van Alfen et al…”

Cervical Radiculopathy vs Parsonage–Turner Syndrome: a Case Report

“…The clinical course is usually self-limiting, and strength gradually returns, but this may be incomplete [35]. Treatment is symptomatic with nonsteroidal anti-inflammatory drugs, narcotics, anticonvalescents, and physical therapy [22,27]. Steroids and antiviral medication were used but there is no consensus whether these medications are indicated [24].…”