Parsonage-Turner Syndrome

Abstract

Background: Parsonage-Turner Syndrome (PTS) is a rare but serious condition characterized by spontaneous paresis of the upper extremity, typically lasting several months with variable recovery. With little literature on the behavior of PTS from a hand surgeon's perspective, accurate diagnosis and subsequent counseling of patients with PTS can be challenging. Methods: This study is a retrospective evaluation of the clinical features of all PTS patients seen over a 9-year period. Data was collected for gender, side affected, handedness, inciting event, clinical presentation, nerve involvement, time taken for recovery, and extent of recovery. Results: Thirty-eight adult cases of PTS were identified, representing an incidence of 0.34 per 1000. Fifty-five percent were female, with predomination of right handedness and dominant upper extremity involvement (60% and 58%, respectively). There was an inciting incident identified in 42% of cases, and 37% of these involved surgery. Twenty-nine percent of cases presented without experiencing typical neuropathic pain. There was a predomination of anterior interosseous nerve (AIN) or posterior interosseous nerve (PIN) involvement (42% overall). Only 44% of patients achieved a complete recovery, taking a mean duration of 10 months. Conclusions: This study highlights both the rarity and atypical spectrum of clinical presentation of PTS, especially considering the more common involvement found for AIN and PIN. This highlights the likelihood that patients presenting with PTS to a hand surgical practice may differ from those typically described in the literature. The poor rate of recovery is in line with other recent reports and contrasts with the more positive outcomes found in earlier studies.

Clinical Spectrum of Postsurgical Parsonage-Turner Syndrome: A Perspective From an Electrodiagnostic Laboratory

“…Following Spillane’s report of “localized neuritis of the shoulder girdle” in 1943 [ 2 ], Parsonage and Turner described 136 cases of neuralgic amyotrophy, specifically, “the shoulder-girdle syndrome” [ 3 ]. The estimated annual incidence of PTS is 1.64 cases per 100,000 population [ 4 , 5 ], although a higher rate of 2-3/100,000 has also been reported [ 1 , 6 ]. Even the latter rate may be an underestimate [ 1 ].…”

“…Right-sided symptoms are more frequent [ 7 ]. PTS is characterized by the acute onset of severe unilateral shoulder girdle/arm pain followed by progressive paresis and atrophy of the muscles innervated by one or more nerves derived from the brachial plexus [ 1 , 3 , 4 , 6 - 8 ]. The severe pain diminishes gradually, and although a dull ache may persist, often the muscle weakness tends to persist longer.…”

“…Winging of the scapula, diminished pinch grip, and weakness of shoulder abduction, external rotation, and forearm pronation are frequently noted [ 1 ]. While any nerve of the brachial plexus may be affected, the upper and middle trunk distribution is the most common, specifically, the long thoracic, suprascapular, musculocutaneous, and/or axillary nerves [ 1 , 6 , 8 , 9 ]. The anterior interosseous nerve (AIN) and posterior interosseous nerve (PIN) have been reported to be more commonly involved in some series [ 6 , 10 ].…”

“…While any nerve of the brachial plexus may be affected, the upper and middle trunk distribution is the most common, specifically, the long thoracic, suprascapular, musculocutaneous, and/or axillary nerves [ 1 , 6 , 8 , 9 ]. The anterior interosseous nerve (AIN) and posterior interosseous nerve (PIN) have been reported to be more commonly involved in some series [ 6 , 10 ]. Diagnosis is based on the clinical picture and electrodiagnostic (EDX) studies; more recently magnetic resonance neurography (MRN) [ 11 ] and ultrasonography (US) have also been found to be valuable [ 12 ].…”

Motor nerve transfers for restoration of upper arm function in adult brachial plexus injuries

“…1 Spinal cord injuries since these patients have intact lower motor neurons below the level of injury with preserved connection to the target muscles 33, 34,35 2 Radiation-induced brachial plexopathy 36 3 Parsonage-Turner syndrome 37,38 4 Contralateral C7 spinal nerve transfer in patients with chronic stroke for motor improvement and reduction of spasticity 39 An ideal timing for nerve transfer has not been yet established. However, it is widely accepted that surgery should be done in a period between 3 and 5 months after injury if there are neither clinical nor electromyographic signs of recovery 29,30,31 .…”