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Brachial Neuritis (Parsonage-Turner Syndrome)

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Topic updated on 10/24/15 4:25pm
Introduction
  • Clinical definition
    • brachial neuritis
    • more formally called neuralgic amyotrophy (AKA Parsonage-Turner syndrome)
  • Epidemiology
    • incidence
      • 1-30 cases per 100,000 persons per year (probably under diagnosed)
    • demographics
      • any age can be affected but typically middle aged individuals affected
      • males more commonly affected than females
    • risk factors
      • viral infection
      • immunizations
      • medications
      • extreme stresses
      • autoimmune diseases
  • Pathophysiology
    • autoimmune process, probably involving lymphocytes
  • Genetics
    • hereditary form is extremely rare but autosomal dominant
Presentation
  • Symptoms
    • sudden onset of intense pain that subsides in 1 to 2 weeks
      • typically awakens people from sleep
    • followed by weakness for a period of up to 1 year in the muscle that is supplied by the involved nerve
  • Physical exam
    • severe weakness of the external rotators and abductors
    • can have decreased sensation (up to 75% of patients)
      • especially in lateral antebrachial cutaneous nerve
    • commonly affects more than one nerve branch
Imaging
  • MRI
    • can show signal abnormalities in the affected muscle bellies
Studies
  • EMG
    • First 3-4 weeks after initial symptoms, abnormalities show acute denervation with sharp waves and fibrillations (in both involved roots and periphery)
Treatment
  • Nonoperative
    • observation for resolution and therapy
      • indications
        • mainstay of treatment
      • technique
        • follow patients monthly for improvement
        • no improvements noted with rehab and observation vs observation alone at one year after diagnosis
      • outcomes
        • 90% of patients recover full muscle strength and function by 3 years with no residual pain or deficits 
        • only 35% of patients recover at 1 year

 

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