Parsonage-Turner Syndrome Revisited

Posted by Daniel Rubio, Drexel University College of Medicine Class of 2014

Parsonage-Turner Syndrome (PTS) is an inflammatory disorder that affects the brachial plexus an important network of nerves which lies deep in the armpit (axilla) giving off nerve brachnes including the axillary, radial, musculocutaneous, ulnar and median nerves which supply power to the shoulder and entire upper extremity.

What does PTS look like?

Unlike other brachial plexopathies, PTS begins spontaneously, without any prior injury to the arm, neck, or axilla.  The classical presentation is severe pain followed by patchy weakness in the shoulder, biceps, and the muscles controlling the thumb and first two fingers (index and middle).  It may also present with a finding known as winged scapula: the shoulder blade sticks out more from the back especially when pushing yourself off a wall.  Weakness may be so severe that the muscles may actually shrink (atrophy).  Pain may be found in the shoulder and along the outside of the upper arm and the thumb-side (lateral) of the forearm and hand.  Pain symptoms usually occur before the weakness and may last up to 4 weeks.  Patients may experience alteration in sensations in the upper extremity, specifically increased sensitivity to touch and temperature and/or tingling.  Symptoms may affect one or both sides, but they usually are asymmetric if they both sides.

 

What causes PTS?

Approximately 50% of patients describe some type of stressful event or illness prior to the onset of symptoms: infection, exercise, surgery, pregnancy, or vaccination.

Diagnosing PTS

Your neurologist can make the diagnosis based on signs and symptoms (especially if you do the above dance); however, sometimes further testing is required to ensure accurate diagnosis.  Suspicion of PTS should occur based upon pattern of initial sudden and severe pain followed by weakness in the upper extremity and slow recovery.  The neurologist may use nerve conduction studies and needle electromyography to document denervation to support clinical suspicion.  Blood tests and imaging rarely help make the diagnosis of PTS.

Help doctor! Fix me?

There is currently no specific treatment for PTS and management usually involves symptom relief.  Pain relief with short course of narcotics may be necessary.  A short course of steroids may be given, which may or may not help relieve symptoms or hasten recovery.  Physical therapy may be prescribed to maintain range of motion and decrease risk of atrophy.  Despite the above measures, there is no treatment to quicken recovery.

When will I be cured?

Recovery of symptoms begins 1-3 months following onset of symptoms; however, maximal recovery may take up to 1-3 years and some patients may be left with residual symptoms.

Advertisements

14 thoughts on “Parsonage-Turner Syndrome Revisited

  1. I was diagnosed with PTS in June symptoms started in April. I am now having issues in left hand with my fingers. I have gained some strength back on my right side but still have the hoorrible pain. I sleep in a recliner as when i sleep in the bed the pain is worse. Should I still be in so much pain?

    • Where is the pain? I had parsonage turner and suffered severe neck pain, couldn’t move my neck, very debilitating, 9/10 pain. The deltoid weakness I could live with but the neck pain was getting to the point of unbearable. After 3 weeks I went to acupressure as I was willing to try anything and they did a special myofascial release of adhesions type of massage, and the pain went down to 0! I’m in no pain now, just have to work on the weakness with physical therapy. With all that inflammation that occurred when you autoimmune attacked your nerves, it caused a lot of adhesion/scar tissue buildup around your muscles, tendons, and nerves. That is extremely painful. Everyone needs to go get a type of myofascial release massage and miraculously the pain goes away. I’m a doctor, by the way. Everything I read in terms of treatment was pain control and physical therapy. But what you really need is the myofascial release massage.

  2. I was diagnosed with PT Jan 30, 2014! I have severe atrophy in my right shoulder and bicep. I have been in therapy for 6 months with very little success. Please help.

  3. Comment posted by Deborah:

    Hi. I am really struggling with parsonage Turner syndrome. I have it in both arms and have been in constant pain for 9 months. I also have leg pain in both legs that started at about the same time. The pain is worse in the right arm and started after a cervical fusion at c5 c6 and c6c7, I am taking 1800 mg of graylese (slow release gabapentine) with no noticeable relief The pain also seemed to get worse over the last few weeks.

    Is it possible to have pts in the legs and if so can they occur at the same time?
    Is there some medication that might supplement or replace the gabapentin?
    Is it possible for pts to get slightly better and then get worse?
    How long might I expect before the pain gets better?
    Is it possible for pts to cause an increase in neck pain Are you treating new patients with pts or do you know of neurologists in CT treating pts?

    Can you help?

    Thank you

    • Deborah, it’s always hard to make a diagnosis without a face to face history and exam. However, I think it your symptoms are unusual for Parsonage Turner syndrome, and it’s important to have the correct diagnosis in order to receive the correct treatment. You should get another opinion – there’s a great neuromusclar neurology program at UConn Hospital for Special Care.

  4. Can anyone help me. Loosing right arm. Oct 17, 2012 took flu shot at Ft.Worth Tx Veterans Clinic. An hour and thirty minutes later I was in brutal pain. I have been shot, stabbed, broken back, six knee surgeries. Nothing hurt like this. I would have rather had been shot. Spent next two weeks in hospital. Ambulance picked me up my bp was 60/40 and almost died. VA was clueless. Shannon Hospital in San Angelo Tx did MRI and said it was PTS. West Texas Rehab worked on my six weeks and said there was nothing the could do. Numbness in right arm and fingers then it just hurts to extreme. Right Arm is drooping and deltoid muscles are about gone. The pain never stops. VA said they would send me to speccialist if I could find any. I served my country for eight years and seems like VA just does not care. Ron Linebarger (Line-bar-ger) 817-846-7212.

    • Sorry to hear about this Ronny, we would suggest that you see a neuromuscular neurology specialist for another opinion- can you ask them to send you to the University of Texas at San Antonio?

    • Ron, I have had it for about 2 years. In my case gabbapentin (aka Neurontin) helped the pain quite a bit. It is non-addictive so you can stay on it for a long time. I took it for 18 mos. You also need to find a good phyisical therapist. Hang in there it takes a long time to heal from this.

      • Roger, Did your pain and disfunction come on very quickly like Ron’s? Mine was more gradual — pain in pec and between shoulder blade and spine for awhile, followed about a month later by intense on-set of pain, spasms and tingling. Still nor 100% convinced it is PTS and not a disc.

      • Rick – mine was more gradual. I thought I had a herniated disc as well and initially was treated that way. I had had a herniated disc in my neck on the other side. MRI showed damage was on the wrong side to be a disc. MRI could eliminate disc. Muscle atrophy came on pretty quickly and for me during the phase when pain was at its worst, that was the difference. I have had tremors during and since the acute phase. Dr that did first EMG got diagnosis right about 2 weeks into acute phase. I found a retired neurosurgeon that just does evaluations got it right as well. You need to get to a Mayo Clinic, Cleveland Clinic type of facility as those are the ones that see the outliers. Next best thing would be a neurologist or neurosurgeon that has had a long career. You will never get a definitive diagnosis as there is no definitive test. I am 99% sure mine is PTS just because of having 2 years of recovery. I have doubted it along the way, but am sure now. Nerves grow at very slow rate so it takes a long time to heal. I am still not fully recovered.

      • Thanks, Roger. I will try to follow up with some more questions and details. So hard to sort all this out when one is so busy. My MRI’s did show impingement at the levels and on the side of the problem. A neurosurgeon concluded that the disc damage was not significant enough to cause the problem, but I still wonder.

  5. Reblogged this on palmitoylethanolamide4pain and commented:
    This syndrome is due to chronic compression and inflammation and subsequently mastcell infiltration in the plexus. The treatment with palmitoylethanolamide (PeaPure) has helped a number of patients: 1 month 3 times 400 mg, second month 3x2x 400 mg in case of insufficient effect, treatment period 2 months before judgement. Various studies in nerve compression syndromes with PEA were positive. The compound is natural, body own and very safe.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s