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Journal of General Internal Medicine

, Volume 33, Issue 2, pp 231–231 | Cite as

Acute Shoulder Pain Followed by Shoulder Weakness and Atrophy: A Characteristic Presentation of Parsonage-Turner Syndrome

  • Sneha Sundaram
  • Ingeborg Schafhalter-Zoppoth
Clinical Practice: Clinical Images
A 79-year-old man presented to clinic 2 months after acute onset of right shoulder pain and weakness. His symptoms began with 1 week of burning pain, followed by inability to lift his right arm above his head. He denied antecedent trauma. Physical examination revealed marked atrophy (Fig. 1) and absence of strength in the shoulder muscles. Sensation, as well as forearm and hand strength, remained intact. Magnetic resonance imaging (MRI) of the shoulder showed atrophy of the infraspinatus, teres minor, posterior deltoid, and subscapularis muscles. Electromyography (EMG) showed severe right upper brachial plexopathy with acute axonal involvement and abundant acute denervation potentials, consistent with the Parsonage-Turner syndrome.
Figure 1

Significant atrophy of the right shoulder 2 months after onset of pain.

Parsonage-Turner syndrome, or “neuralgic amyotrophy,” is a rare idiopathic disorder characterized by acute onset of upper extremity pain, with subsequent development of muscle weakness and atrophy.1 , 2 The exact pathophysiology is unknown, but is hypothesized to include immunologic, biomechanical, and genetic factors.3 Nerves of the brachial plexus are most commonly affected. Parsonage-Turner syndrome is a clinical diagnosis, as EMG has low sensitivity.3 Recovery can take months to years, and is often incomplete. There is no evidence-based treatment, and management is supportive.2 Eighteen months after symptom onset, the patient has not recovered strength in his shoulder.

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

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    Smith CC, Bevelaqua AC. Challenging pain syndromes: Parsonage-Turner syndrome. Phys Med Rehabil Clin N Am. 2014;25(2):265–77.CrossRefPubMedGoogle Scholar
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    van Alfen N, van Engelen BGM, Hughes RAC. Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis). Cochrane Database Syst Rev. 2009;(3):1-16.Google Scholar
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    Van Eijk JJ, Groothuis JT, Van Alfen N. Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment. Muscle Nerve. 2016;53(3):337–50.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  1. 1.San FranciscoUSA

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