Parsonage-Turner syndrome (PTS)

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Parsonage-Turner syndrome (PTS), also known as neuralgic amyotrophy, manifests as a rare neuromuscular disorder, often presenting with sudden onset shoulder pain on one side of the body. However, its symptoms can vary, with some experiencing gradual onset of symptoms or involvement of both shoulders and other body parts.

Whatever your symptoms are, you can count on the experts at Aurora Health Care to identify your condition and find the best treatments for you.

What is Parsonage-Turner syndrome?

Parsonage-Turner syndrome typically begins with sharp, aching, burning or stabbing pain in one shoulder, which may radiate to the neck, arm and hand on the same side of the body. During the acute phase, the pain can be severe and persistent, often worsening in the evenings and at night. Over time, the PTS pain may go away when you’re not using your shoulder but flare up with certain movements.

In its chronic phase, Parsonage-Turner syndrome may present as low-grade pain lasting for a year or more, accompanied by progressive weakness of the shoulder muscles. This weakness can lead to shrinking and thinning of the affected muscles (atrophy).

About 75% of cases occur only once. If episodes recur they may involve the same or different nerves. Parsonage-Turner syndrome is also categorized as a type of peripheral neuropathy.

Causes of Parsonage-Turner syndrome

Image shows the peripheral nerves that make up the brachial plexus passing through the shoulder to extend down the arm.
Image shows nerves of the brachial plexus starting from the spinal cord and passing through the shoulder. These nerves may be affected by Parsonage-Turner syndrome, which causes extreme shoulder pain and muscle weakness.

We don’t know what causes Parsonage-Turner syndrome. Research seems to show it’s connected to an abnormal inflammatory response from the immune system that attacks the brachial plexus nerves located by the shoulder.

Various factors may contribute to the onset of PTS, including recent viral illnesses, vaccinations, previous surgeries on the brachial plexus, infections, anesthesia, rheumatologic diseases, autoimmune disorders and childbirth. However, in some instances, no specific trigger can be identified.

Risk factors for Parsonage-Turner syndrome

While individuals of any age can be affected, Parsonage-Turner syndrome is more common among people around the age of 40, young children and the elderly. Men are affected more than women.

Symptoms of Parsonage-Turner syndrome

Initial symptoms of Parsonage-Turner syndrome typically involve severe pain followed by muscle weakness. As the condition progresses, you may experience symptoms such as:

  • Absent or reduced reflexes
  • Sensory deficits such as numbness or unusual sensations like tickling, prickling or burning
  • Lower back pain
  • Shortness of breath due to effects on the diaphragm
  • Hoarseness and soft speech from effects on the laryngeal nerve
  • Skin discoloration or spotting on the hands due to affected blood vessels
  • Increased hair and nail growth

Parsonage-Turner syndrome symptoms may alter your responses to temperature, including abnormal sweating or feeling cold in the hands and forearms.

Parsonage-Turner syndrome diagnosis

Prompt diagnosis is crucial for effective treatment. Your doctor will conduct a physical examination and discuss your symptoms with you. Specialized imaging tests, such as electromyography (EMG), magnetic resonance neurography, MRI, ultrasound or nerve conduction studies may be used to confirm the PTS diagnosis.

Parsonage-Turner syndrome treatment

Since the exact cause of Parsonage-Turner syndrome remains unknown, treatment primarily focuses on managing symptoms:

  • Medications for pain management are key components.
  • Immobilization may be recommended during the acute phase to alleviate pain.

After EMG testing shows evidence that your nerves are starting to regenerate, physical therapy will be recommended. Parsonage-Turner syndrome treatment may include physical therapy exercises for strengthening and stretching muscles to regain strength and range of motion.

Occupational therapy can help you learn strategies for coping with daily activities.

In some cases, surgery may be considered to repair nerve damage from Parsonage-Turner syndrome. Your doctor will use imaging to assess the suitability of surgery for your condition.

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