A health condition that causes sudden and intense pain in the shoulder and upper arm, followed by muscle weakness, is called Parsonage-Turner syndrome (PTS). While it may last a few days, in some cases, these symptoms can last for weeks or even months. Furthermore, there are multiple treatment options that help ease pain and muscle weakness.
In other words, this is a neurological disorder that causes sudden and severe pain in certain parts of the body. It often occurs due to damage to the brachial plexus. This is a network of nerves that begins from the spine through the neck and goes into both armpits and then down to the arms. PTS primarily affects motor nerves and axons. Thus, these nerves cannot do their job (to control movements), which is one of the causes a person with PTS experiences muscle weakness.
Furthermore, this condition is often misdiagnosed because it occurs quite rarely, and there are other conditions that cause similar symptoms. For example, cervical radiculopathy (pinched nerve), cervical spondylosis, and others.
The name of this condition is after 2 British neurologists, Maurice Personage and John Turner. First time, this condition was described in 1948 as:
- Brachial neuritis, plexus neuritis, or plexus neuropathy
- Idiopathic brachial plexus neuropathy
- Neuralgic amyotrophy
Phases of Parsonage-Turner Syndrome
Usually, this condition has 3 phases. For example:
- Phase 1 (acute pain phase) – During this phase, people often experience severe and sudden pain in one shoulder. It often lasts a few days to weeks. The recovery time often depends on how long this phase lasts.
- Phase 2 – This phase begins when the pain goes away, and you may develop muscle weakness (including arm and shoulder girdle weakness). Commonly, it leads to paralysis that may last up to 18 months or even longer.
- Phase 3 – Over time, you will regain the strength and functionality of your muscles.
This condition occurs quite rarely and affects about 3 per 100,000 each year.
Symptoms
The primary symptoms of PTS are sudden pain and muscle weakness that often affect a person’s shoulder, upper arm, forearm, and hand. Furthermore, in about 80% this disorder affects only one arm, and in approximately 20% of cases, it negatively affects both arms. In rare cases, PTS may cause pain and muscle weakness in the lower trunk and extremities.
Usually, pain caused by PTS occurs suddenly, and it is often sharp and intense. This symptom usually worsens at night. While some people experience pain for a few hours, others may experience it for weeks. Therefore, muscle weakness occurs in the affected part of the body when the pain goes away. In addition, muscle weakness often occurs in the shoulder or upper arm, but it may also impact your forearm and hand. Over time, this symptom of PTS may lead to muscle atrophy.
In general, the severity of symptoms varies among people with this disorder because it depends on which nerves are affected. Check below for other symptoms of PTS:
- Problems with reflexes in the affected arm
- Unusual sensations (paresthesia) or numbness in the affected arm. It often feels like prickling, burning, or tickling.
- Partial shoulder dislocation
- Abnormal range or motion in the affected joints
- Winged scapula (it occurs when the shoulder blade sticks out)
- Shortening of the muscles or tendons in the affected limbs
- Purple, red, or spotted hands due to poor circulation
- Swelling
- Shortness of breath (also known as dyspnea)
If any of the previous symptoms occur, immediately contact your healthcare professional.
Causes
Healthcare providers do not fully understand why this disorder occurs. However, they think a reaction of the immune system causes it. In general, there are two theories about the contributors. For example:
- Viral, bacterial, or parasitic infections that directly impact the brachial plexus
- Antibodies that attack bacteria, viruses, or antigens, causing damage to the brachial plexus
One of the common triggers of PTS is a recent viral infection. Check below some examples:
- HIV (human immunodeficiency virus) infection
- Fifth disease (parvovirus B19)
- Mumps
- Smallpox (variola major and minor)
- Coxsackie B virus (it often causes several health conditions, including pneumonia, gastrointestinal conditions, myocarditis, aseptic meningitis, encephalitis, and viral hepatitis)
Sometimes, doctors cannot identify what exactly causes PTS symptoms. Rarely, this disorder can be inherited (genetic). In such cases, it is known as hereditary neuralgic amyotrophy.
Risk Factors
While it is not possible to determine the exact cause of PTS, healthcare professionals have identified some factors that could increase your risk of developing it. Check below some of them:
- Recent surgery or anesthesia
- Connective tissue disease (such as Ehlers-Danlos syndrome)
- Autoimmune disorders (including systemic lupus erythematosus, temporal arteritis, and polyarteritis nodosa)
- Traumatic shoulder injury
- Strenuous exercise that involves the shoulder
- Vaccines
- Pregnancy and childbirth
- Radiation therapy (this is a cancer treatment used to destroy cancerous cells throughout the body)
- Lumbar puncture (also called spinal tap)
- Getting contrast dye used for imaging testing
Complications
People with this disorder may also experience some complications, especially if they do not get treatment. Check below some of them:
- Chronic pain
- Muscle atrophy
- Loss of function
- Joint problems
- Paresthesia
- Skin or voice changes
- Scapular winging
- Respiratory problems
- Nerve compression syndromes (such as Carpal Tunnel syndrome)
- An increased risk of bone fractures
This document does not contain a full list of PTS complications. However, you can talk with your doctor about measures to reduce the risk of the previous complications. In addition, there is no way to prevent this disorder because healthcare professionals do not know what exactly causes it.
Diagnosis
First, physicians will evaluate your medical history and perform a physical examination to check for irregularities linked to the disease. They may also ask some questions and perform some tests for muscle strength, reflexes, and feeling in your arm. When doctors suspect PTS, they may recommend a test known as EMG (electromyography). It is used to evaluate the health and function of skeletal muscles and nerves that are responsible for controlling them. Furthermore, doctors may also perform the following tests to rule out other disorders that cause similar symptoms. Check below some examples:
- MRI (magnetic resonance imaging) scans
- Nerve ultrasound
- CT (computed tomography) scans
Treatment
In general, there are no specific treatments for this disorder. However, in some cases, PTS may go away on its own without treatment. The prognosis of this disorder can be improved with early diagnosis and proper treatment. Usually, treatment for this disease involves multiple healthcare specialists. For example:
- Primary care physicians (PCPs)
- Orthopedists
- Neurologists
- Neuromuscular disease specialists
- Physical therapists
Check below some treatments often recommended by doctors for people with PTS:
- Analgesics (pain medicines, such as over-the-counter nonsteroidal anti-inflammatory drugs)
- Oral corticosteroids
- Immobilizing the affected part of the body
- TENS (transcutaneous electrical nerve stimulation)
- Acupuncture
- Physical therapy – During this therapy, doctors will teach you specific exercises to improve the function and strength of the affected muscles.
- Co-analgesics – Your doctor may also prescribe one of the following medicines to relieve nerve pain. For example, Gabapentin, Carbamazepine, or Amitriptyline.
In severe cases, patients often need surgery to relieve the symptoms.
Frequently Asked Questions
What is the most common cause of Parsonage-Turner syndrome?
While doctors cannot identify what exactly causes PTS, they have identified some factors that may elevate your risk of developing it. For example:
- Traumatic shoulder injury
- Vaccines
- Pregnancy
- Lumbar puncture
- Cancer treatments (such as radiation therapy) and others
Can you fully recover from Parsonage-Turner syndrome?
Unfortunately, there is no way to cure this condition. That’s why the treatment focuses on relieving the symptoms and preventing serious complications.
What are the long-term effects of Parsonage-Turner syndrome?
People who develop PTS, may also experience some complications. These include chronic pain, prolonged muscle weakness, muscle atrophy, functional impairment, and others. Ask your healthcare provider if you have additional questions.
