Parsonage Turner syndrome
Overview
Inflammation of the nerves that carry signals from the spine to the shoulder, arm and hands.
Symptoms
* Shoulder pain * Upper arm pain * Atrophic paralysis of shoulder muscles * Muscle weakness * Muscle wasting * Hyperesthesia
Causes
The exact cause of PTS is unknown, but the condition has been linked to many previous events or illnesses such as: * viral infection (particularly of the upper respiratory tract) * bacterial infection (e.g., pneumonia, diphtheria, typhoid) * parasitic infestation * surgery * trauma (not related to shoulder) * vaccinations (e.g., influenza, tetanus, diphtheria, tetanus toxoids, pertussis, smallpox, swine flu) * childbirth * miscellaneous medical investigative procedures (e.g., lumbar puncture, administration of radiologic dye) * systemic illness (e.g., polyarteritis nodosa, lymphoma, systemic lupus erythematosus, temporal arteritis, Ehlers-Danlos syndrome) In addition to these possible causes, a rare hereditary form of PTS has been localized to a defect on chromosome 17, and should be considered a distinct disorder. This form of the disorder occurs in a younger age group, affects males and females equally (autosomal-dominant inheritance), and is characterized by recurrent attacks that often cause pain on both sides of the body. Acute pain in the shoulder girdle or arm is almost always the first symptom. Shortly thereafter, muscle weakness and wasting in the shoulder girdle and arm occur. The pain, which may be extraordinarily severe for a short time, eventually abates.
Diagnosis
PTS is a clinical syndrome, and therefore diagnosis is made by exclusion. Other disorders of the upper extremity or cervical spine have to be excluded, including abnormalities of the rotator cuff, acute calcific tendinitis, adhesive capsulitis, cervical radiculopathy, peripheral nerve compression, acute poliomyelitis, and amyotrophic lateral sclerosis (ALS). PTS may sometimes be confused with peripheral nerve compression or traction injury of the brachial plexus. Affected persons, however, do not experience the acute intense pain associated with PTS, and the loss of strength occurs simultaneously with the sensory changes. In PTS, x rays of the cervical spine and shoulder show normal findings compatible with the patient's age. Nerve conduction studies and electromyography (EMG) are helpful in localizing the lesion. Three to four weeks after the onset of pain, EMG studies show changes consistent with PTS. Arthrography or ultrasound may be useful to rule out a tear of the rotator cuff. MRI may reveal muscles changes associated with PTS.
Prognosis
The 'prognosis' of Parsonage Turner syndrome usually refers to the likely outcome of Parsonage Turner syndrome. The prognosis of Parsonage Turner syndrome may include the duration of Parsonage Turner syndrome, chances of complications of Parsonage Turner syndrome, probable outcomes, prospects for recovery, recovery period for Parsonage Turner syndrome, survival rates, death rates, and other outcome possibilities in the overall prognosis of Parsonage Turner syndrome. Naturally, such forecast issues are by their nature unpredictable.
Treatment
No specific treatment has yet been proved efficient in Parsonage-Turner syndrome. In the early stages, pain may require treatment. Common pan-killers are usually sufficient. As pain subsides, physiotherapy is recommended. Passive range of motion exercises of the shoulder and elbow are suggested to maintain full range of motion. Active rehabilitation is undertaken only when some recovery of the affected muscle(s) is already obtained. Furthermore, all the upper body muscles should undergo rehabilitative exercises, and not only those presenting clinical weakness. It is also recommended that strength recovery reaches a plateau before patient returns to sports.