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Parsonage-Turner Syndrome

  • Electrodiagnosis Corner/Review Article
  • Published:
HSS Journal

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.

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References

  1. Allan SG, Towla HMA, Smith CC, Downie AW: Painful brachial plexopathy: an unusual presentation of polyarteritis nodosa. Postgrad Med J 58: 311–313, 1982

    Article  CAS  PubMed  Google Scholar 

  2. Allen IM: The neurological complication of serum treatment. Lancet, 2: 1128–1131, 1931

    Article  Google Scholar 

  3. Anderton JM, Schady W, Markham DE: An unusual case of postoperative brachial palsy. B J Anaesth 72: 605, 1994

    Article  CAS  Google Scholar 

  4. Beghi E, Kurland LT, Mulder DW, Nicolosi A: Brachial plexus neuropathy in the population of Rochester, Minnesota. Ann Neurol 18: 320–323, 1985

    Article  CAS  PubMed  Google Scholar 

  5. Besleaga D, Castellano V, Lutz C, Feinberg JH: Musculocutaneous neuropathy: case report and discussion. HSS Journal 6: 112–116, 2009.

    Article  Google Scholar 

  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, 1979

    CAS  Google Scholar 

  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, 1990

    CAS  PubMed  Google Scholar 

  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, 1997

    Article  CAS  Google Scholar 

  9. Braddom RL, Wolfe C: Musculocutaneous nerve injury after heavy exercise. Arch Phys Med Rehabil. 59: 280–283, 1978

    Google Scholar 

  10. Cape CA, Fincham RW: Paralytic brachial neuritis with diaphragmatic paralysis; contralateral recurrence. Neurology 15: 191–193, 1965

    CAS  PubMed  Google Scholar 

  11. Challenoh Y, Richter R, Bruun B et al: Non-traumatic plexitis and heroin addiction. JAMA, 225: 958–961, 1973

    Article  Google Scholar 

  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, 2003

    Article  CAS  Google Scholar 

  13. Claussen GC, Tseng A, Mussel H, Kwon KH, Oh SJ: Cervical root involvement in neuralgic amyotrophy. Muscle Nerve 20: 1071, 1997

    Google Scholar 

  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. 1991

    CAS  PubMed  Google Scholar 

  15. Cwik VA, Wilbourn AJ, Rorick M: Acute brachial neuropathy: detailed EMG findings in a large series. Muscle Nerve 13: 859, 1990

    Google Scholar 

  16. Dawson DM, Karup C: Perioperative nerve lesions. Arch Neurol 46: 1355, 1989

    CAS  PubMed  Google Scholar 

  17. deGraff A: Neuralgic amyotrophy in identical twins with Erlos-Danlos syndrome. Eur Neurol 9: 190–196, 1973

    Article  Google Scholar 

  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, 1980

    CAS  Google Scholar 

  19. Doyle JB: Neurologic complications of serum sickness. Am J Med Sci, 185: 484–492, 1933

    Article  Google Scholar 

  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, 2004

    CAS  PubMed  Google Scholar 

  21. Dumitru D: Brachial plexopathies and proximal mononeuropathies. Electrodiagnostic medicine, 2nd edn. New York: Mosby, 2002, pp. 623–624

    Google Scholar 

  22. Dworkin RH, Corbin AE, Young JP, Jr, et al.: Pregabalin for the treatment of postherpetic neuralgia. Neurology 50: 1274–1283, 2003

    Google Scholar 

  23. Dyke SC: Peripheral nerve lesions after anti-tetanic serum. Lancet 1: 570, 1918

    Article  Google Scholar 

  24. Eggers KA, Asai T: Post-operative brachial plexus neuropathy after total knee replacement under spinal anaesthesia. Br J Anaesth 75: 642–644, 1995

    CAS  PubMed  Google Scholar 

  25. Englart HM: Partial fascicular median nerve atrophy of unknown region. Handchirurgie 8: 61–62, 1976

    Google Scholar 

  26. Evans B, Stevens C, Dyck P: Lumbosacral plexus neuropathy. Neurology 31: 1327–1330, 1981

    CAS  PubMed  Google Scholar 

  27. Feinberg J: Fall von Erb-Klumpke scher Lahmung nach influenza. Central Bl 16: 588–637, 1897

    Google Scholar 

  28. Feinberg JH, Doward, DA, Gonsalves A: Cervical radiculopathy vs Parsonage Turner Syndrome: a case report. HSS Journal 3(1):106–111, 2006

    Article  Google Scholar 

  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, 1986

    CAS  PubMed  Google Scholar 

  30. Fibuch, EE, Mertz, J, Geller, B: Postoperative onset of idiopathic brachial neuritis. Anesthesiology 84: 455–458, 1996

    Article  CAS  PubMed  Google Scholar 

  31. Flaggman PD, Kelly JJ: Brachial plexus neuropathy: an electrophysiological evaluation. Arch Neurol 37: 160–164, 1980

    CAS  PubMed  Google Scholar 

  32. Friedenberg SM, Zimprich T, Harper CM: The natural history of long thoracic and spinal accessory neuropathies. Muscle Nerve 25(4):535–539, 2002

    Article  PubMed  Google Scholar 

  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, 1970

    Article  CAS  PubMed  Google Scholar 

  34. Gnann JWJ, Whitley RJ: Clinical practice. Herpes zoster. N Engl J Med 347: 340–346, 2002

    Article  PubMed  Google Scholar 

  35. Gregory RP, Loh L, Newsom-Davis J. Recurrent isolated alternating phrenic nerve palsies: a variant of brachial neuritis. Thorax 45: 420–421, 1990

    Article  CAS  PubMed  Google Scholar 

  36. Hardy RW Jr, Wilbourn AJ: Thoracic outlet syndromes, in Wilkins RH, Renachary SS (eds): Neurosurgery, 2nd edn. New York: McGraw-Hill, 1996, pp 306–3074

    Google Scholar 

  37. Haussmann P, Kendel K: Oligofascicular median nerve compression syndrome. Handchirurgie 13: 268–271, 1981

    CAS  PubMed  Google Scholar 

  38. Hill NA, Howard FM, Huffer BR: The incomplete anterior interosseous nerve syndrome. J Hand Surg 10(1):4–16, 1985

    CAS  Google Scholar 

  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, 2005

    Article  PubMed  Google Scholar 

  40. Jacob JC, Andermann F, Robb JP: Heredofamilial neuritis with brachial predilection. Neurology 11: 1025–1033, 1961

    CAS  PubMed  Google Scholar 

  41. James JL, Miles DW: Neuralgic amyotrophy: a clinical and electromyographic study. Br Med J 2: 1042–1043, 1966

    Article  CAS  PubMed  Google Scholar 

  42. Jebsen RH: Motor conduction velocities in the median and ulnar nerves. Arch Phys Med Rehabil 48: 185–194, 1967

    CAS  PubMed  Google Scholar 

  43. Kayed K, Kass B: Acute multiple brachial neuropathy and Erlos-Danlos syndrome. Neurology (Minneap) 29: 1620–1621, 1979

    CAS  Google Scholar 

  44. Kost, RG, Straus, SE: Postherpetic neuralgia—pathogenesis, treatment, and prevention. The New England Journal of Medicine 335: 32–42, 1996

    Article  CAS  PubMed  Google Scholar 

  45. Kroll DA, Caplan RA, Posner K, Ward RJ, Cheney FW: Nerve injury associated with anesthesia. Anesthesiology 73: 202–207, 1990

    Article  CAS  PubMed  Google Scholar 

  46. Lahrmann H, Grisold W, Authier FJ, Zifko UA: Neuralgia Amyotrophy with phrenic nerve involvement. Muscle Nerve 22: 437–442, 1999

    Article  CAS  PubMed  Google Scholar 

  47. Magee KR, DeJong RN: Paralytic brachial neuritis. J Am Med Assoc 174: 1258–1262, 1960

    CAS  Google Scholar 

  48. Malamut RI, Marques W, England JD, Sumner AJ: Post-surgical idiopathic brachial neuritis. Muscle Nerve17: 320–324, 1994

    Article  CAS  PubMed  Google Scholar 

  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, 2005

    PubMed  Google Scholar 

  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, 1987

    CAS  PubMed  Google Scholar 

  51. Martin WA, Kraft GH: Shoulder girdle neuritis: a clinical and electrophysiologic evaluation. Mil Med 139: 21–25, 1974

    CAS  PubMed  Google Scholar 

  52. Mastaglia FL: Musculocutaneous neuropathy after strenuous physical activity. Med J Aust 125(3–4): 153–154, 1986

    Google Scholar 

  53. McCarty E, Tsairis P, Warren R: Brachial neuritis. Clin Orthop Relat Res 368: 37–43, 2006

    Google Scholar 

  54. McGillicuddy JE: Cervical radiculopathy, entrapment neuropathy, and thoracic outlet syndrome: how to differentiate? J Neurosurg (Spine 1) 2: 179–187, 2004

    Article  Google Scholar 

  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 2201–2228

    Google Scholar 

  56. Misamore, GW, Lehman, DE: Parsonage Turner syndrome. J Bone Jt Surg 78A:1405–1408, 1996

    Google Scholar 

  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, 1993

    CAS  PubMed  Google Scholar 

  58. Nagano A: Spontaneous anterior interosseous nerve palsy. JBJS (Br) 85B: 313–318, 2003

    Google Scholar 

  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, 1996

    Article  Google Scholar 

  60. Neviaser AS, Hannafin JA: Adhesive capsulitis: a review of current treatment. Am J Sports Med PreView XX: 1–11, 2010

    Google Scholar 

  61. Parsonage MJ, Turner JWA: The shoulder girdle syndrome. Lancet 1: 973–978, 1948

    Article  CAS  PubMed  Google Scholar 

  62. Pearce JMS, Jishi AA: Neuralgic amyotrophy: a complication of radiological contrast material. Lancet 1: 1400, 1985

    Article  CAS  PubMed  Google Scholar 

  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, 1996

    CAS  PubMed  Google Scholar 

  64. Rennels GD, Ochoa J: Neuralgia amyotrophy manifesting as anterior interosseous nerve palsy. Muscle Nerve 3: 160–164, 1980

    Article  CAS  PubMed  Google Scholar 

  65. Rowbotham MC, Fields HL: Topical lidocaine reduces pain in postherpetic neuralgia. Pain 37: 297–301, 1989

    Article  Google Scholar 

  66. Rowbotham MC, Petersen KL: Zoster-associated pain and neural dysfunction. Pain 93: 1–5, 2001

    Article  CAS  PubMed  Google Scholar 

  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, 1983

    Article  Google Scholar 

  68. Sander J, Sharp J: Lumbosacral plexus neuritis. Neurology, 31: 470–473, 1981

    CAS  PubMed  Google Scholar 

  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, 1999

    Article  CAS  PubMed  Google Scholar 

  70. Schott GD: A chronic and painless form of brachial plexus neuropathy. J Neurol Neurosurg Psychiatry 46: 555–557, 1983

    Article  CAS  PubMed  Google Scholar 

  71. Spillane JD: Localized neuritis of the shoulder girdle. Lancet 2: 532–535, 1943

    Article  Google Scholar 

  72. Spurling, R, Segerberg L: Lateral intervertebral disk lesions in the lower cervical region JAMA 151: 354–359, 1953

    CAS  Google Scholar 

  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.

  74. Stewart JD: Focal Peripheral Neuropathies, 3 edn. Philadelphia: Lippincott Williams & Wilkins, 2000

    Google Scholar 

  75. Subramony SH: Neuralgia Amyotrophy. EE Case Report # 14 3-8 1988

  76. Sunderland S: The intraneural topography of the radial, median and ulnar nerves. Brain 68: 243–299, 1945

    Article  Google Scholar 

  77. Taylor R: Heredofamilial mononeuritis with brachial predilection. Brain. 83: 113–137, 1960

    Article  CAS  PubMed  Google Scholar 

  78. Tsairis, P, Dyck PJ, Mulder DW: Natural history of brachial plexus neuropathy. Report on 99 patients. Arch Neurol 27: 109–117, 1972

    CAS  PubMed  Google Scholar 

  79. Turner J: Acute brachial radiculitis. Br Med J, 2: 992–994, 1944

    Google Scholar 

  80. Turner J, Parsonage MJ: Neuralgia amyotrophy (paralytic brachial neuritis) with special reference to prognosis. Lancet 2: 209–212, 1957

    Google Scholar 

  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, 1995

    CAS  PubMed  Google Scholar 

  82. Urschel HC Jr, Razzuk MA: Neurovascular compression in the thoracic outlet. Changing management over 50 years. Ann Surg 228: 609–617, 1998

    Article  PubMed  Google Scholar 

  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.

  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, 2006

    Article  Google Scholar 

  85. Walsh NE, Dumitru D, Kalantri A, Roman Jr AM: Brachial neuritis involving the bilateral phrenic nerves, Arch Phys Med Rehabil 68: 46–48, 1987

    CAS  PubMed  Google Scholar 

  86. Warner MA, Warner ME, Martin JT: Ulnar neuropathy: incidence, outcome, and risk factors in sedated or anesthetized patients. Anesthesiology 81: 1332–1340, 1994

    Article  CAS  PubMed  Google Scholar 

  87. Watson CP, Evans RJ: Effect of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology 50: 1837–1841, 1998

    CAS  PubMed  Google Scholar 

  88. Weikers NJ, Mattson RH: Acute paralytic brachial neuritis: a clinical and electrodiagnostic study. Neurology 19: 1153–1158, 1969

    CAS  PubMed  Google Scholar 

  89. Weinstein EA: Localized non-traumatic neuropathy in military personnel. Arch Neurol Psychiatry 57: 369–376, 1947

    CAS  PubMed  Google Scholar 

  90. Weintraub MI, Chia DTS: Paralytic brachial neuritis after swine flu vaccination. Arch Neurol 34: 518, 1977

    CAS  PubMed  Google Scholar 

  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, 1998

    Article  CAS  PubMed  Google Scholar 

  92. Wolpow ER: Brachial plexus neuropathy. Association with desensitizing antiallergy injections JAMA 234: 620–621, 1975

    Article  CAS  PubMed  Google Scholar 

  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, 1997

    Google Scholar 

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  1. Physiatry Department, Hospital for Special Surgery, 523 East 72nd Street, 2nd Floor, New York, NY, 10021, USA

    Joseph H. Feinberg MD

  2. Weill Cornell Medical College, 525 E 68th St., Box 142, New York, NY, 10065, USA

    Jeffrey Radecki MD

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  1. Joseph H. Feinberg MD
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Correspondence to Joseph H. Feinberg MD.

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Feinberg, J.H., Radecki, J. Parsonage-Turner Syndrome. HSS Jrnl 6, 199–205 (2010). https://doi.org/10.1007/s11420-010-9176-x

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