Effectiveness of an outpatient rehabilitation programme in patients with neuralgic amyotrophy and scapular dyskinesia: a randomised controlled trial

Abstract

BackgroundNeuralgic amyotrophy (NA) is an acute inflammation of nerves within the brachial plexus territory leading to severe pain and multifocal paresis resulting in >60% of patients having residual complaints and functional limitations correlated with scapular dyskinesia. Our primary aim was to compare the effects of multidisciplinary rehabilitation (MR), focused on motor relearning to improve scapular dyskinesia and self-management strategies for reducing pain and fatigue, with usual care (UC) on shoulder, arm and hand functional capability in patients with NA.MethodsIn a non-blinded randomised controlled trial (RCT), patients with NA (aged≥18 years, scapular dyskinesia, >8 weeks after onset) were randomised to either an MR or an UC group. MR consisted of a diagnostic multidisciplinary consultation and eight sessions of physical and occupational therapy. Primary outcome was functional capability of the shoulder, arm and hand assessed with the Shoulder Rating Questionnaire–Dutch Language Version (SRQ-DLV).ResultsWe included 47 patients with NA; due to drop-out, there were 22 participants in MR and 15 in UC for primary analysis. The mean group difference adjusted for sex, age and SRQ-DLV baseline score was 8.60 (95%CI: 0.26 to 16.94, p=0.044). The proportion attaining a minimal clinically relevant SRQ-DLV improvement (≥12) was larger for the MR group (59%) than the UC group (33%) with a number needed to treat of 4.ConclusionThis RCT shows that an MR programme focused on motor relearning to improve scapular dyskinesia, combined with self-management strategies for reducing pain and fatigue, shows more beneficial effects on shoulder, arm and hand functional capability than UC in patients with NA.Trial registration numberNCT03441347.

Idiopathic Neuralgic Amyotrophy in a Child Treated with Integrated Rehabilitation Program: A Case Report

“…The other study suggested a multidisciplinary rehabilitation program according to patient's needs and goals. The program was shown to improve participants' functional capability with minimal pain [8]. In that study, however, the participants were older than 18 years and had more than 8 weeks after onset.…”

“…Some studies report that an immunotherapy could be effective for pain control and neurologic recovery. Additionally, a multidisciplinary rehabilitation program is suggested for functional improvement and reduction of musculoskeletal complications [6][7][8].…”

Multimodal Rehabilitation Management of a Misunderstood Parsonage–Turner Syndrome: A Case Report during the COVID-19 Pandemic

“…Currently, in the literature, the rehabilitation process lacks certainty, but some elements seem effective and are widely used, such as neurodynamic techniques [ 20 ]. Recent studies have shown that a multidisciplinary approach appears valid in managing these patients, emphasizing the importance of sensorimotor recovery, including exercises for regaining upper limb proprioceptive abilities and motor imagery [ 9 , 10 ]. A factor that had a positive influence on the patient’s prognosis in this case report is his young age, motivation, active lifestyle, and adherence to the therapeutic plan (the patient attended all the scheduled sessions).…”

“…This aspect is crucial since 60% of patients have residual weakness 2–3 years after the onset of the disease; over 50% are limited by pain; 63% experience severe fatigue; and 82% face difficulties in daily activities [ 8 ]. Several strategies have recently been proposed for the rehabilitation of PTS patients, such as a structured multidisciplinary approach that has proven effective [ 9 , 10 ]. This case report shows, for the first time, through an objective strength evaluation system, how recovery can occur even after three years and the role that a progressive multimodal rehabilitation treatment can have in achieving outcomes.…”

Peripherally-induced Movement Disorders: An Update

“…Although rotatory movements of the scapula and other abnormal involuntary movements of the shoulder are typical manifestations of dystonic tics in patients with Tourette syndrome, shoulder involuntary movements may be peripherally induced. One cause of shoulder (scapular) dyskinesia is neuralgic amyotrophy [117]. This condition, manifested by episodes of acute pain in the proximal arm, presumably due to acute autoimmune inflammation of the nerves in the brachial plexus, is often associated with abnormal involuntary movements of the shoulder.…”