Incidence of neuralgic amyotrophy (Parsonage–Turner syndrome) in a primary care setting: A prospective cohort study

Abstract

ObjectiveNeuralgic amyotrophy is considered a rare peripheral nervous system disorder but in practice seems grossly under recognized, which negatively affects care for these patients. In this study we prospectively counted the one-year incidence rate of classic neuralgic amyotrophy in a primary care setting. MethodsIn a prospective cohort study during the year 2012 we registered all new cases of neck, shoulder or arm complaints from two large primary care centers serving a population of 14,118. Prior to study, general practitioners received a short training on how to diagnose classic neuralgic amyotrophy. Neuralgic amyotrophy was defined according to published criteria irrespective of family history. Only patients with a classic phenotype were counted as definite cases. After inclusion, patients with suspected neuralgic amyotrophy who had not yet seen a neurologist were offered neurologic evaluation for diagnostic confirmation. ResultsOf the 492 patients identified with new onset neck, shoulder or arm complaints, 34 were suspected of having neuralgic amyotrophy. After neurologic evaluation the diagnosis was confirmed in 14 patients. This amounts to a one-year incidence rate for classic neuralgic amyotrophy of 1 per 1000. Data Availability Statement: No centralized data collection was available for this study. Data were collected in an anonymized digital datafile and stored locally by the study group. The primary data file for this study is available as S1 Datafile.Funding: This study was sponsored by an unsolicited and unconditional gift from the Dutch Rare Diseases Fund (Stichting Zeldzame Ziekten Fonds; www.zzf.nl) and the ZABAWAS Foundation (www. zabawas.nl). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ConclusionsOur findings suggest that neuralgic amyotrophy is 30-50 times more common than previously thought. Unawareness of the disorder and its clinical presentation seems the most likely explanation for this difference. An incidence rate of 1 per 1000 and the long-term sequelae many patients suffer warrant more vigilance in diagnosing the disorder, to pave the way for timely treatment and prevent complications.

Backpack palsy and other brachial plexus neuropathies in the military population

“…For NA we calculated an incidence of 18/10 000 person years. This is considerably higher than 1‐3/100 000 person years that is historically found in the literature, but lower than recent prospective research showed after training of general practitioners in the general population (up to 1/1000 person years) . As military personnel and military doctors are not trained to recognize NA, we think our incidence of NA is still an underestimation and might be even higher than in the general population.…”

“…Neuralgic amyotrophy is a clinically defined syndrome characterized by acute onset, severe pain in the shoulder and/or upper arm(s), with subsequent multifocal peripheral nervous system symptoms that can be bilateral but are always asymmetric. Criteria for this disorder have been described in previous publications …”

“…While there currently is a reasonable amount of knowledge in the literature about NA in the general population, which seems to be a common form of plexopathy with an estimated incidence of 1 per 1000 in The Netherlands, information on BPP is limited and consists of small studies. The purpose of this study was to gain insight in the incidence, severity and recovery of soldiers with brachial plexus neuropathies in the Dutch military population and to compare disease characteristics between patients with BPP and patients with NA.…”

Hepatitis E virus and neurological injury

“…It is possible that HEV3 causes a specific phenotypic variant of neural gic amyotrophy with these features. Recent data suggest that the incidence of neuralgic amyotrophy in primary care could be as high as 1 per 1,000 per year, which is 30-50 times more frequent than previously thought 92 . The prevalence of HEV among milder cases of neuralgic amyotrophy remains an open question.…”

Neuralgic Amyotrophy Attributed Incorrectly to Block-Related Injury

“…[4][5][6] In brief, NA is a relatively rare disorder (1-year incidence 1-3 per 100,000 in a 1985 Minnesota study 7 ; 1-year incidence 1/1000 individuals in a 2015 the Netherlands study 8 ). Although classically a brachial plexus affliction, NA may involve other nerves.…”