Typical Brachial Neuritis (Parsonage-Turner Syndrome) With Hourglass-Like Constrictions in the Affected Nerves

Pan, Yuanjiang; Wang, Shufeng; Gao, Tian; Li, Chun; Tian, Wen; Tian, Mei

doi:10.1016/j.jhsa.2011.03.041

Cited by 66 publications

(64 citation statements)

References 21 publications

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“…The presence of prodromal pain in many AINS patients and the potential for spontaneous symptomatic resolution, however, are more suggestive of an inflammatory and/or ischemic, rather than compressive, etiology. The frequency of fascicular abnormalities of the median nerve proper described in this and other studies provides further evidence for a noncompressive neuropathy …”

Section: Discussionsupporting

confidence: 74%

Fascicular constrictions above elbow typify anterior interosseous nerve syndrome

et al. 2019

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Introduction In this study we tested the hypothesis that fascicular constrictions (FCs) of the median nerve proximal to the elbow joint characterize anterior interosseous nerve syndrome (AINS). Methods Magnetic resonance neurography (MRN) and ultrasound (US) examinations were evaluated in 45 patients with clinically suspected AINS. All 22 patients at site 1 underwent MRN and 8 underwent US; all 23 patients at site 2 underwent US. Results Median nerve FCs were identified in all MRN cases; FCs and/or fascicular enlargements were identified in 88% of US cases. Most FCs were in the mediannerve posterior/posteromedial region and were proximal to the elbow joint line (mean distance: MRN, 5.4 cm; US, 7.5 cm), with the exception of a single FC (located 1 cm distal). No extrinsic compression of median or anterior interosseous nerves was identified in the arm or forearm. Discussion AINS is a noncompressive neuropathy characterized by median nerve FCs in the arm.

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Section: Discussionsupporting

confidence: 74%

Fascicular constrictions above elbow typify anterior interosseous nerve syndrome

et al. 2019

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“…In a series of 5 patients, Pan et al . were the first to directly associate the hourglass‐like constriction with neuralgic amyotrophy, based on the same clinical presentation of both conditions …”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement, and torsion

et al. 2015

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Objective: To characterize the ultrasonographic findings on nerves in neuralgic amyotrophy.Methods: Fourteen patients with neuralgic amyotrophy were examined using high resolution ultrasound.Results: Four types of abnormalities were found: 1. Focal or diffuse nerve / fascicle enlargement (57%), 2. incomplete nerve constriction (36%), 3. complete nerve constriction with torsion (50%) (hourglass-like appearance), and 4. fascicular entwinement (28%). Torsions were confirmed intraoperatively and occurred on the radial nerve in 85% of the patients. A significant correlation was found between no spontaneous recovery of nerve function and constriction / torsion / fascicular entwinement (p=0.007). Conclusion:Ultrasonographic nerve pathology in neuralgic amyotrophy varies in order of severity from nerve enlargement to constriction to nerve torsion, with treatment moving from conservative to surgical. We postulate that the constriction caused by inflammation is the precursor of torsion and that the development of nerve torsion is facilitated by rotational movements of limbs.

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“…In addition to immunotherapy there have been several recent reports on surgical treatments of typical brachial neuritis patients in whom nerves that were affected by hourglass constriction (as shown by nerve ultrasound and intraoperative observations) underwent successful neurolysis or resection with grafting . In selected cases with severe axillary nerve damage and no signs of recovery after 6–9 months, a radial‐to‐axillary nerve transfer may be considered for reinnervating the deltoid muscle .…”

Section: Treatment In the Acute Phasementioning

confidence: 99%

Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment

Groothuis²,

2016

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In this review we provide a current overview of the clinical features, pathophysiology, epidemiology, and diagnostic and therapeutic strategies in neuralgic amyotrophy (NA). The disorder has several phenotypic variations, with a classic form in 70% of the patients. It is not rare, with an incidence of 1 per 1,000 individuals, but it is still often missed. Recurrences are common, yet the proposed multifactorial etiology, which includes genetic, biomechanical, and immunologic factors, limits our capacity to predict or prevent them. NA is a clinical diagnosis, and ancillary studies serve to exclude infectious or malignant causes or to assess a differential diagnosis. If patients are seen early and are still in pain, a short trial of high-dose oral corticosteroids is advised, and adequate analgesia may require opioids and non-steroidal anti-inflammatory drugs. Persistent complaints are common, and a multidisciplinary rehabilitation approach focusing on scapular coordination, energy distribution strategies, and self-management is indicated.

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Typical Brachial Neuritis (Parsonage-Turner Syndrome) With Hourglass-Like Constrictions in the Affected Nerves

Cited by 66 publications

References 21 publications

Fascicular constrictions above elbow typify anterior interosseous nerve syndrome

Fascicular constrictions above elbow typify anterior interosseous nerve syndrome

Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement, and torsion

Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment

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