Parsonage Turner Syndrome – Causes, Symptoms, Diagnosis and Treatment
Parsonage Turner Syndrome or Brachial Plexopathy or Brachial Plexus Dysfunction or Brachial Neuritis is a rare condition that affects the upper arm and the shoulder. It is characterized by the sudden onset of pain in these parts which is followed by distinct weakness in the muscles of the upper arm and wasting of the shoulder girdle.
Lower motor neurons of the brachial plexus are affected in this syndrome. A bundle of nerves, brachial plexus, transmits signals from the spine to the shoulder, arms and the chest. Inflammation of these nerves limits the movement of the affected arm. Moreover, as the pain alleviates, the patient may experience numbness which gradually leads to paralysis of the shoulder and upper arm in Parsonage Turner Syndrome.
Causes of Brachial Plexopathy:
Although the exact cause of this condition is not known, damage to the brachial plexus caused due to a direct injury to the nerves could be one of the causes. Moreover, tumors in the upper arm and shoulder region, radiation therapy damage and stretching injuries such as birth trauma could also lead to the development of this syndrome.
Symptoms of Brachial Plexus Dysfunction:
- Sudden, severe and burning pain that begins at the top of the shoulder blade.
- Pain may last for a few hours to a fortnight.
- Localized pain in the shoulder region is the most prominent symptom.
- Severe and constant pain that is associated with the tenderness of muscles.
- Pain is aggravated by moving the arms and muscle pressure, but neck movements do not have any affect.
- Pain radiates to the forearm affecting the area below the elbow.
- As the pain subsides, paralysis in the shoulder region may develop which manifests in the form of wasting of the affected muscles and limpness.
- Abnormal sensations, numbness, burning and tingling pain in the shoulder region.
- Weakness while flexing the hand.
- Reduced reflexes in the arms.
- Fine tremors or fasciculations are occasionally experienced in some cases.
How is Parsonage Turner Syndrome Diagnosed?
A detailed examination of the shoulder, hand and wrist usually helps in identifying the problem if any with the brachial plexus nerves. Diagnostic tests such as chest x-ray, nerve conduction tests, Electromyogram (EMG), blood tests, nerve biopsy (required rarely) and MRI of the shoulder, head and neck are done to confirm the condition.
Complications Associated with Brachial Neuritis:
Following are the complications the patients of this condition may suffer from.
- Partial or complete paralysis of the affected arm.
- Arm deformity which could be mild or severe.
- Unnoticed or recurring injuries on the affected arm due to decreasing sensation.
- Loss of sensation in the affected arm.
Treatment of Parsonage Turner Syndrome:
The main aim of the treatment options is to rectify the cause of the condition and aid in the normal movement of the affected arm.
- In the initial stages, pain relieving medications are recommended. Prescription or over the counter medications such as tricyclic antidepressants (nortriptyline, amitriptyline), anticonvulsants (carbamazepine, pregabalin, phenytoin and gabapentin) help in alleviating the pain. However, the dosage should be the least to begin with to avoid any side-effetcs.
- Physical therapy in the affected region is recommended when the pain begins to subside. Exercises that help in the movement of the shoulder and elbow should be practiced.
- Orthopedic assistance in the form of splints or braces may be taken.
- Patients who experience pain even after using pain relievers may opt for tendon transfers or surgical options.
- Surgery may be beneficial in patients suffering from Parsonage Turner Syndrome due to nerve compression.
Nearly 75% recovery has been observed in patients within a period of 2 years. In some other cases, complete recovery was seen. Recovery depends on the duration and severity of pain.