HSS Journal

, Volume 6, Issue 2, pp 199–205 | Cite as

Parsonage-Turner Syndrome

Electrodiagnosis Corner/Review Article

Abstract

Parsonage-Turner Syndrome (PTS), also referred to as idiopathic brachial plexopathy or neuralgic amyotrophy, is a rare disorder consisting of a complex constellation of symptoms with abrupt onset of shoulder pain, usually unilaterally, followed by progressive neurologic deficits of motor weakness, dysesthesias, and numbness. Although the etiology of the syndrome is unclear, it is reported in various clinical situations, including postoperatively, postinfectious, posttraumatic, and postvaccination. The identification of the syndrome in the postoperative patient remains a challenge as symptoms may easily be attributed to sequelae of surgical positioning, postoperative recovery, or postanesthetic block pain. The purpose of this review is to bring forth salient, identifiable factors which may assist the surgical clinician in identifying the condition sooner. An early and proper diagnosis affords the opportunity to treat the patient accordingly and to the satisfaction of both surgeon and patient.

Keywords

Parsonage-Turner Syndrome brachial neuritis, brachial amyotrophy 

References

  1. 1.
    Allan SG, Towla HMA, Smith CC, Downie AW: Painful brachial plexopathy: an unusual presentation of polyarteritis nodosa. Postgrad Med J 58: 311–313, 1982CrossRefPubMedGoogle Scholar
  2. 2.
    Allen IM: The neurological complication of serum treatment. Lancet, 2: 1128–1131, 1931CrossRefGoogle Scholar
  3. 3.
    Anderton JM, Schady W, Markham DE: An unusual case of postoperative brachial palsy. B J Anaesth 72: 605, 1994CrossRefGoogle Scholar
  4. 4.
    Beghi E, Kurland LT, Mulder DW, Nicolosi A: Brachial plexus neuropathy in the population of Rochester, Minnesota. Ann Neurol 18: 320–323, 1985CrossRefPubMedGoogle Scholar
  5. 5.
    Besleaga D, Castellano V, Lutz C, Feinberg JH: Musculocutaneous neuropathy: case report and discussion. HSS Journal 6: 112–116, 2009.CrossRefGoogle Scholar
  6. 6.
    Bloch SL, Jarrett MP, Swerdlow M, Grayzel AI: Brachial plexus neuropathy as the initial presentation of systemic lupus erythematosus. Neurology (Minneap) 29: 1633–1634, 1979Google Scholar
  7. 7.
    Boden SD, McCowin PR, Davis DO, et al: Abnormal magnetic-resonance scan of cervical spine in asymptomatic patients: a prospective investigation. J Bone Joint Surg Am 72: 1178–1184, 1990PubMedGoogle Scholar
  8. 8.
    Bowsher D. The effects of pre-emptive treatment of postherpetic neuralgia with amitriptyline: a randomized, double blind, placebo-controlled trial. J Pain Symptoms Manage 13: 327–331, 1997CrossRefGoogle Scholar
  9. 9.
    Braddom RL, Wolfe C: Musculocutaneous nerve injury after heavy exercise. Arch Phys Med Rehabil. 59: 280–283, 1978Google Scholar
  10. 10.
    Cape CA, Fincham RW: Paralytic brachial neuritis with diaphragmatic paralysis; contralateral recurrence. Neurology 15: 191–193, 1965PubMedGoogle Scholar
  11. 11.
    Challenoh Y, Richter R, Bruun B et al: Non-traumatic plexitis and heroin addiction. JAMA, 225: 958–961, 1973CrossRefGoogle Scholar
  12. 12.
    Chong AY, Clarke CE, Dimitri WR et al. Brachial plexus injury as an unusual complication of coronary artery bypass graft surgery. Postgrad Med 79: 84, 2003CrossRefGoogle Scholar
  13. 13.
    Claussen GC, Tseng A, Mussel H, Kwon KH, Oh SJ: Cervical root involvement in neuralgic amyotrophy. Muscle Nerve 20: 1071, 1997Google Scholar
  14. 14.
    Crooks RJ, Jones DA, Fiddian AP: Zoster-associated chronic pain: an overview of clinical trials associated with acyclovir. Scand J Infect Dis Suppl 80: 62–68. 1991PubMedGoogle Scholar
  15. 15.
    Cwik VA, Wilbourn AJ, Rorick M: Acute brachial neuropathy: detailed EMG findings in a large series. Muscle Nerve 13: 859, 1990Google Scholar
  16. 16.
    Dawson DM, Karup C: Perioperative nerve lesions. Arch Neurol 46: 1355, 1989PubMedGoogle Scholar
  17. 17.
    deGraff A: Neuralgic amyotrophy in identical twins with Erlos-Danlos syndrome. Eur Neurol 9: 190–196, 1973CrossRefGoogle Scholar
  18. 18.
    Devathasan G, Tong HI: Neuralgia amyotrophy: criteria for diagnosis and a clinical with electromyographic study of 21 cases. Aust NZ J Med 10: 188–191, 1980Google Scholar
  19. 19.
    Doyle JB: Neurologic complications of serum sickness. Am J Med Sci, 185: 484–492, 1933CrossRefGoogle Scholar
  20. 20.
    Dubinsky RM, Kabbani H, El-Chami Z, et al: Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 63: 959–965, 2004PubMedGoogle Scholar
  21. 21.
    Dumitru D: Brachial plexopathies and proximal mononeuropathies. Electrodiagnostic medicine, 2nd edn. New York: Mosby, 2002, pp. 623–624Google Scholar
  22. 22.
    Dworkin RH, Corbin AE, Young JP, Jr, et al.: Pregabalin for the treatment of postherpetic neuralgia. Neurology 50: 1274–1283, 2003Google Scholar
  23. 23.
    Dyke SC: Peripheral nerve lesions after anti-tetanic serum. Lancet 1: 570, 1918CrossRefGoogle Scholar
  24. 24.
    Eggers KA, Asai T: Post-operative brachial plexus neuropathy after total knee replacement under spinal anaesthesia. Br J Anaesth 75: 642–644, 1995PubMedGoogle Scholar
  25. 25.
    Englart HM: Partial fascicular median nerve atrophy of unknown region. Handchirurgie 8: 61–62, 1976Google Scholar
  26. 26.
    Evans B, Stevens C, Dyck P: Lumbosacral plexus neuropathy. Neurology 31: 1327–1330, 1981PubMedGoogle Scholar
  27. 27.
    Feinberg J: Fall von Erb-Klumpke scher Lahmung nach influenza. Central Bl 16: 588–637, 1897Google Scholar
  28. 28.
    Feinberg JH, Doward, DA, Gonsalves A: Cervical radiculopathy vs Parsonage Turner Syndrome: a case report. HSS Journal 3(1):106–111, 2006CrossRefGoogle Scholar
  29. 29.
    Ferrini L, Della-Torre P, Perticoni G, Cantisani TA: Neuralgic amyotrophy of the shoulder girdle: the Parsonage Turner Syndrome. Ital J Orthop Traumatol 12: 223–231, 1986PubMedGoogle Scholar
  30. 30.
    Fibuch, EE, Mertz, J, Geller, B: Postoperative onset of idiopathic brachial neuritis. Anesthesiology 84: 455–458, 1996CrossRefPubMedGoogle Scholar
  31. 31.
    Flaggman PD, Kelly JJ: Brachial plexus neuropathy: an electrophysiological evaluation. Arch Neurol 37: 160–164, 1980PubMedGoogle Scholar
  32. 32.
    Friedenberg SM, Zimprich T, Harper CM: The natural history of long thoracic and spinal accessory neuropathies. Muscle Nerve 25(4):535–539, 2002CrossRefPubMedGoogle Scholar
  33. 33.
    Gilliatt RW, Le Quesne PM, Logue V, et al.: Wasting of the hand associated with a cervical rib or band. J Neurol Neurosurg Psychiatry 33: 615–624, 1970CrossRefPubMedGoogle Scholar
  34. 34.
    Gnann JWJ, Whitley RJ: Clinical practice. Herpes zoster. N Engl J Med 347: 340–346, 2002CrossRefPubMedGoogle Scholar
  35. 35.
    Gregory RP, Loh L, Newsom-Davis J. Recurrent isolated alternating phrenic nerve palsies: a variant of brachial neuritis. Thorax 45: 420–421, 1990CrossRefPubMedGoogle Scholar
  36. 36.
    Hardy RW Jr, Wilbourn AJ: Thoracic outlet syndromes, in Wilkins RH, Renachary SS (eds): Neurosurgery, 2nd edn. New York: McGraw-Hill, 1996, pp 306–3074Google Scholar
  37. 37.
    Haussmann P, Kendel K: Oligofascicular median nerve compression syndrome. Handchirurgie 13: 268–271, 1981PubMedGoogle Scholar
  38. 38.
    Hill NA, Howard FM, Huffer BR: The incomplete anterior interosseous nerve syndrome. J Hand Surg 10(1):4–16, 1985Google Scholar
  39. 39.
    Huang YC, Wang HC, Tsai YF, Chang SF, Hsu WC: Postsurgical brachial neuritis after orthognathic surgery. A case report. J Oral Maxillofac Surg 63: 1387–1390, 2005CrossRefPubMedGoogle Scholar
  40. 40.
    Jacob JC, Andermann F, Robb JP: Heredofamilial neuritis with brachial predilection. Neurology 11: 1025–1033, 1961PubMedGoogle Scholar
  41. 41.
    James JL, Miles DW: Neuralgic amyotrophy: a clinical and electromyographic study. Br Med J 2: 1042–1043, 1966CrossRefPubMedGoogle Scholar
  42. 42.
    Jebsen RH: Motor conduction velocities in the median and ulnar nerves. Arch Phys Med Rehabil 48: 185–194, 1967PubMedGoogle Scholar
  43. 43.
    Kayed K, Kass B: Acute multiple brachial neuropathy and Erlos-Danlos syndrome. Neurology (Minneap) 29: 1620–1621, 1979Google Scholar
  44. 44.
    Kost, RG, Straus, SE: Postherpetic neuralgia—pathogenesis, treatment, and prevention. The New England Journal of Medicine 335: 32–42, 1996CrossRefPubMedGoogle Scholar
  45. 45.
    Kroll DA, Caplan RA, Posner K, Ward RJ, Cheney FW: Nerve injury associated with anesthesia. Anesthesiology 73: 202–207, 1990CrossRefPubMedGoogle Scholar
  46. 46.
    Lahrmann H, Grisold W, Authier FJ, Zifko UA: Neuralgia Amyotrophy with phrenic nerve involvement. Muscle Nerve 22: 437–442, 1999CrossRefPubMedGoogle Scholar
  47. 47.
    Magee KR, DeJong RN: Paralytic brachial neuritis. J Am Med Assoc 174: 1258–1262, 1960Google Scholar
  48. 48.
    Malamut RI, Marques W, England JD, Sumner AJ: Post-surgical idiopathic brachial neuritis. Muscle Nerve17: 320–324, 1994CrossRefPubMedGoogle Scholar
  49. 49.
    Mamula, CJ, Ernhard RE, Piva SR: Cervical radiculopathy or Parsonage-Turner syndrome: differential diagnosis of a patient with neck and upper extremity symptoms. J Orthop Sports Phys Ther 35: 659–664, 2005PubMedGoogle Scholar
  50. 50.
    Marra TR: The clinical and electrodiagnostic features of idiopathic lumbo-sacral and brachial plexus neuropathy: a review of 20 cases. Electromyogr Clin Neurophysiol 27: 305–315, 1987PubMedGoogle Scholar
  51. 51.
    Martin WA, Kraft GH: Shoulder girdle neuritis: a clinical and electrophysiologic evaluation. Mil Med 139: 21–25, 1974PubMedGoogle Scholar
  52. 52.
    Mastaglia FL: Musculocutaneous neuropathy after strenuous physical activity. Med J Aust 125(3–4): 153–154, 1986Google Scholar
  53. 53.
    McCarty E, Tsairis P, Warren R: Brachial neuritis. Clin Orthop Relat Res 368: 37–43, 2006Google Scholar
  54. 54.
    McGillicuddy JE: Cervical radiculopathy, entrapment neuropathy, and thoracic outlet syndrome: how to differentiate? J Neurosurg (Spine 1) 2: 179–187, 2004CrossRefGoogle Scholar
  55. 55.
    McGillicuddy JE, Sullivan SE: Entrapment/compression neuropathies, in Batjer HH, Loftus CM (eds): Textbook of Neurological Surgery. Principles and Practice. Philadelphia: Lippincott Williams & Wilkins, 2003, pp 2201–2228Google Scholar
  56. 56.
    Misamore, GW, Lehman, DE: Parsonage Turner syndrome. J Bone Jt Surg 78A:1405–1408, 1996Google Scholar
  57. 57.
    Mulvey DA, Aquilina RJ, Elliottt MW, Moxham J, Green M: Diaphragmatic dysfunction in neuralgic amyotrophy: an electrophysiologic evaluation of 16 patients presenting with dyspnea. Am Rev Respir Dis, 147: 66–71, 1993PubMedGoogle Scholar
  58. 58.
    Nagano A: Spontaneous anterior interosseous nerve palsy. JBJS (Br) 85B: 313–318, 2003Google Scholar
  59. 59.
    Nagano A, Shibata K, Tokimura H, Yamamoto S, Tajiri Y: Spontaneous anterior interosseous nerve palsy with hourglass-like fascicular constriction within the main trunk of the media nerve. J Hand Surg (Am) 21A: 266–270, 1996CrossRefGoogle Scholar
  60. 60.
    Neviaser AS, Hannafin JA: Adhesive capsulitis: a review of current treatment. Am J Sports Med PreView XX: 1–11, 2010Google Scholar
  61. 61.
    Parsonage MJ, Turner JWA: The shoulder girdle syndrome. Lancet 1: 973–978, 1948CrossRefPubMedGoogle Scholar
  62. 62.
    Pearce JMS, Jishi AA: Neuralgic amyotrophy: a complication of radiological contrast material. Lancet 1: 1400, 1985CrossRefPubMedGoogle Scholar
  63. 63.
    Pellegrino JE, Rebbeck TR, Brown MJ, Bird TD, Chance PF: Mapping of hereditary neuralgic amyotrophy (familial brachial plexus neuropathy) to distal chromosome 17Q. Neurology 46: 1128–1132, 1996PubMedGoogle Scholar
  64. 64.
    Rennels GD, Ochoa J: Neuralgia amyotrophy manifesting as anterior interosseous nerve palsy. Muscle Nerve 3: 160–164, 1980CrossRefPubMedGoogle Scholar
  65. 65.
    Rowbotham MC, Fields HL: Topical lidocaine reduces pain in postherpetic neuralgia. Pain 37: 297–301, 1989CrossRefGoogle Scholar
  66. 66.
    Rowbotham MC, Petersen KL: Zoster-associated pain and neural dysfunction. Pain 93: 1–5, 2001CrossRefPubMedGoogle Scholar
  67. 67.
    Sanchez MC, Arinellas JIC, Gutierrez DA, Alonzo JLG, Alvarez JDP: Cervical radiculopathy: a rare symptom of giant cell arteritis. Arthritis Rheum 26: 207–209, 1983CrossRefGoogle Scholar
  68. 68.
    Sander J, Sharp J: Lumbosacral plexus neuritis. Neurology, 31: 470–473, 1981PubMedGoogle Scholar
  69. 69.
    Savader SJ, Omdal DG, Venbrux AC: Brachial plexus neuropathy: A rare complication of patient positioning during interventional radiological procedures. J Vasc Interv Radiol 10: 579, 1999CrossRefPubMedGoogle Scholar
  70. 70.
    Schott GD: A chronic and painless form of brachial plexus neuropathy. J Neurol Neurosurg Psychiatry 46: 555–557, 1983CrossRefPubMedGoogle Scholar
  71. 71.
    Spillane JD: Localized neuritis of the shoulder girdle. Lancet 2: 532–535, 1943CrossRefGoogle Scholar
  72. 72.
    Spurling, R, Segerberg L: Lateral intervertebral disk lesions in the lower cervical region JAMA 151: 354–359, 1953Google Scholar
  73. 73.
    Staff NP, Engelstad J, Dyck PJ, et al. Immune-mediated postsurgical neuropathy. M-62 American Neurological Association 134th Annual Meeting Poster Session Abstracts Oct 2009.Google Scholar
  74. 74.
    Stewart JD: Focal Peripheral Neuropathies, 3 edn. Philadelphia: Lippincott Williams & Wilkins, 2000Google Scholar
  75. 75.
    Subramony SH: Neuralgia Amyotrophy. EE Case Report # 14 3-8 1988Google Scholar
  76. 76.
    Sunderland S: The intraneural topography of the radial, median and ulnar nerves. Brain 68: 243–299, 1945CrossRefGoogle Scholar
  77. 77.
    Taylor R: Heredofamilial mononeuritis with brachial predilection. Brain. 83: 113–137, 1960CrossRefPubMedGoogle Scholar
  78. 78.
    Tsairis, P, Dyck PJ, Mulder DW: Natural history of brachial plexus neuropathy. Report on 99 patients. Arch Neurol 27: 109–117, 1972PubMedGoogle Scholar
  79. 79.
    Turner J: Acute brachial radiculitis. Br Med J, 2: 992–994, 1944Google Scholar
  80. 80.
    Turner J, Parsonage MJ: Neuralgia amyotrophy (paralytic brachial neuritis) with special reference to prognosis. Lancet 2: 209–212, 1957Google Scholar
  81. 81.
    Tyring S, Barbarash RA, Nahlik JE, et al. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia: a randomized, double-blind placebo-controlled trial. Ann Intern Med 123: 89–96, 1995PubMedGoogle Scholar
  82. 82.
    Urschel HC Jr, Razzuk MA: Neurovascular compression in the thoracic outlet. Changing management over 50 years. Ann Surg 228: 609–617, 1998CrossRefPubMedGoogle Scholar
  83. 83.
    van Alfen N, van Engelen BGM, Hughes RAC. Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis). Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006976.Google Scholar
  84. 84.
    Van Tujil JH, Schmid A, van Kranen-Mastenbroek VHJM, Faber CG, Vles JSH: Isolated spinal accessory neuropathy in an adolescent: a case study. J European Paediatric Neurology Society. 10: 83–85, 2006CrossRefGoogle Scholar
  85. 85.
    Walsh NE, Dumitru D, Kalantri A, Roman Jr AM: Brachial neuritis involving the bilateral phrenic nerves, Arch Phys Med Rehabil 68: 46–48, 1987PubMedGoogle Scholar
  86. 86.
    Warner MA, Warner ME, Martin JT: Ulnar neuropathy: incidence, outcome, and risk factors in sedated or anesthetized patients. Anesthesiology 81: 1332–1340, 1994CrossRefPubMedGoogle Scholar
  87. 87.
    Watson CP, Evans RJ: Effect of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology 50: 1837–1841, 1998PubMedGoogle Scholar
  88. 88.
    Weikers NJ, Mattson RH: Acute paralytic brachial neuritis: a clinical and electrodiagnostic study. Neurology 19: 1153–1158, 1969PubMedGoogle Scholar
  89. 89.
    Weinstein EA: Localized non-traumatic neuropathy in military personnel. Arch Neurol Psychiatry 57: 369–376, 1947PubMedGoogle Scholar
  90. 90.
    Weintraub MI, Chia DTS: Paralytic brachial neuritis after swine flu vaccination. Arch Neurol 34: 518, 1977PubMedGoogle Scholar
  91. 91.
    Wilbourn AJ, Aminoff MI: AAEM minimonograph 32: the electrodiagnostic exam in patients with radiculopathies. American Association of Electrodiagnostic Medicine. Muscle Nerve 21: 1612–1631, 1998CrossRefPubMedGoogle Scholar
  92. 92.
    Wolpow ER: Brachial plexus neuropathy. Association with desensitizing antiallergy injections JAMA 234: 620–621, 1975CrossRefPubMedGoogle Scholar
  93. 93.
    Wong L, Dellon AL: Brachial neuritis presenting as anterior interosseous nerve compression—implications for diagnosis and treatment: a case report. J Hand Surg 22A: 536–539, 1997Google Scholar

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© Hospital for Special Surgery 2010

Authors and Affiliations

  1. 1.Physiatry DepartmentHospital for Special SurgeryNew YorkUSA
  2. 2.Weill Cornell Medical CollegeNew YorkUSA

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