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.
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.