Parsonage-Turner Syndrome Initially Suspected of Being Orthopedic Diseases in a Primary Care Setting: A Case Report

Abstract

Parsonage-Turner syndrome (PTS), also known as neuralgic amyotrophy or brachial neuritis, consists of a complex set of symptoms including sudden onset shoulder pain, usually unilaterally, followed by progressive neurologic deficits such as motor weakness, dysesthesia and numbness. We report a case of a 45-year-old Japanese man with PTS, who was initially suspected of having orthopedic diseases, such as cervical spondylosis and suprascapular nerve entrapment syndrome. The patient presented with acute-onset severe pain in his right arm and neck, followed by muscle weakness. We diagnosed PTS by taking a detailed medical history, ruling out other differential diagnoses, and by considering the characteristic clinical symptoms and the denervation pattern identified by needle electromyography. High-dose corticosteroid therapy prednisolone (PSL) relieved the initial sharp pain and oral amitriptyline successfully relieved the residual nighttime pain. Doses of PSL and amitriptyline were tapered, pain was alleviated, and the patient returned to full-time work after discharge in one-and-a-half years. For prompt diagnosis, physicians should consider the possibility of PTS in patients with acute onset of severe arm pain or subsequent muscle weakness and muscle atrophy in the arm or shoulder girdle.

Parsonage-Turner Syndrome Caused by Parvovirus B19: A Case Report and Review of Literature

“…The treatment consists of reducing the pain using tramadol, fentanyl, corticosteroids, lidocaine and amitriptyline, among others. Amitriptyline has been useful for neuropathic pain and as an additional treatment when the pain is incessant [4].…”

Compression neuropathy as a cause for painful shoulder

“…Neuralgic amyotrophy predominantly affects males, with male‐to‐female ratios ranging from 2:1 to 11.5:1. The highest incidence occurs between the third and seventh decades . It usually presents unilaterally, but according to one study of 246 cases of neuralgic amyotrophy, which analysed the characteristics of the condition, it found 28.5% of patients reported to have bilateral involvement .…”

“…There is no evidence suggestive of a tendency for the right or left arm and no correlation with hand dominance . The condition had been known to be self‐limiting, showing good recovery without specific treatment . The most significant finding that raises suspicion for identifying neuralgic amyotrophy relies on elucidating the pattern of denervation of the muscles.…”

Parsonage-Turner syndrome in a patient with bilateral shoulder pain: A case report

“…Diagnosis is further complicated by the heterogeneity of symptoms among patients, which vary according to the nerves injured and the speed at which the disease progresses 4 ) . Therefore, a comprehensive approach involving accurate history taking, physical examination, and specific tests (e.g., electromyography and brachial plexus magnetic resonance imaging [MRI]) is required to ensure proper diagnosis, while delay of diagnosis and treatment may result in lasting functional damage 5 ) . In the present report, we discuss the case of a young woman with bilateral shoulder pain who received a final diagnosis of Parsonage-Turner syndrome, focusing on the perspective required for diagnosis of the disease in rural areas.…”