Atypical Presentation of Parsonage-Turner Syndrome

Ibrahim, Ramzi; Krivitsky, Michael; Nicola, Monica; Zarour, Christopher C.

doi:10.7759/cureus.8892

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…The diagnosis is primarily clinical, based on a thorough medical history and pathological findings in the physical examination and electromyographic (EMG) exam. Additional diagnostic work-up, including laboratory and imaging, offer support mainly by ruling out other possible etiologies [5] , [6] , [7] . Therefore, PTS should always be considered in the differential diagnosis of acute-onset shoulder pain.…”

Section: Discussionmentioning

confidence: 99%

Anterior interosseous nerve lession and distal myoclonus revealing a parsonage turner syndrome associated with hashimoto thyroiditys

Musa

Rahman

Siddik

et al. 2021

Radiology Case Reports

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Parsonage-Turner Syndrome (PTS), also known as brachial neuritis or neuralgic amyotrophy, is a rare disorder affecting 2 to 3 individuals per 100,000 each year. Abrupt onset shoulder pain, followed by motor weakness, paresthesia and hypoesthesia, is usually reported, lasting several months with variable recovery. The etiology of the disease may be idiopathic or triggered by an underlying autoimmune disease in genetically susceptible individuals. Our report addresses a unique case of Parsonage-Turner Syndrome in a patient suffering from concurrent Hashimoto Thyroiditis. A previously healthy A 22 year-old female was referred to the Department of Neurology after complaints of sudden-onset motor weakness in her left upper limb. On physical examination, the patient could not make an “Ok sign” with her thumb and distal phalanx or form a complete fist, revealing weakness within the anterior interosseous branch of the median nerve. Further testing with electromyography demonstrated muscular atrophy within the arm's anterior compartment, forearm, and triceps brachii of the posterior compartment. Additional imaging and physical examination were unremarkable, confirming our diagnosis of PTS. Furthermore, lab reports revealed elevated levels of anti-thyroglobulin and anti-thyroid peroxidase antibodies and our patient was concurrently diagnosed with Hashimoto's thyroiditis. This case aims to highlight the rare co-occurrence of Hashimoto's thyroiditis with Parsonage-Turner Syndrome in an otherwise healthy patient. A 2014 study published by Nugent et al. had also shed light on brachial neuritis in a patient suffering from autoimmune connective tissue disease, and through this case study, we hope to add to the growing literature regarding the correlation between PTS and autoimmune diseases. Symptoms of PTS can easily be misdiagnosed given its similarity to other peripheral neuropathies, and careful assessment and thorough understanding of the disease is required to successfully distinguish it from other neurological pathologies.

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Section: Discussionmentioning

confidence: 99%

Anterior interosseous nerve lession and distal myoclonus revealing a parsonage turner syndrome associated with hashimoto thyroiditys

Musa

Rahman

Siddik

et al. 2021

Radiology Case Reports

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show abstract

“…[1,6] the literary data available, only a few cases with the clinical presentation of painless neuralgic amyotrophy after surgery or vaccination have been reported. [7,8] Treatment is supportive, as there are currently no evidence based pharmacological or rehabilitation interventions. [8,9,10,11] In our patient, the initial signs were motor weakness and muscle atrophy, which progressed for about 3 weeks after the inciting event; actually, the lack of pain was the atypical manifestation of this syndrome.…”

Section: Discussionmentioning

confidence: 99%

Painless Neuralgic Amyotrophy (Parsonage-Turner Syndrome) – A Case Report

Vasileva,

Stoev,

Danovska

et al. 2024

JofIMAB

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Background: Neuralgic amyotrophy (NA) is a rare disorder typically characterized by an abrupt onset of upper extremity pain followed by progressive muscle weakness, atrophy and occasional sensory loss. Although NA has been hypothesized to be an autoimmune-mediated disorder. It is considered a primarily clinical diagnosis, electrodiagnostic evaluation is essential for the diagnosis confirmation and can exclude other etiologies. Electrodiagnostic findings can reveal patchy damage to any nerve within the brachial plexus. Case Description: In the current case report, we are presenting a 43-years-old man admitted to the Neurology Department of “UMHAT Dr. Georgi Stranski” in Pleven, Bulgaria, with decreased muscle strength and limited active movements in the left upper shoulder for approximately 3 weeks. The patient denied feeling any pain during the onset and afterwards. He had no previous infections, vaccinations and history of other diseases. The detailed neurological examination showed the left upper extremity decreased antigravity strength in the deltoid and infraspinatus muscles with marked atrophy of the same. Hyporeflexia of the left biceps and brachioradialis deep‐tendon reflexes was present. Electromyography findings showed denervation of the deltoid and infraspinatus muscles. Initial reinnervation of supraspinatus and cervical paraspinal muscles was present. The diagnosis of NA was confirmed by both the neurological examination and the electrophysiological findings. Conclusion: We are presenting a clinical case of idiopathic neuralgic amyotrophy with atypical painless presentation and discussing the most significant aspects of the disorder with regards to the difficulties in approaching the correct diagnosis. A better understanding of the NA clinical symptoms and signs variability improves the diagnostic and therapeutic approach.

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“…This is the main study limitation. Ibrahim et al [ 37 ] claimed that although physiotherapy improves and alleviates PTS symptoms, it does not improve recovery duration. Tsairis et al [ 4 ] reported that a recovery in 80% of patients with PTS occurs after two years, and 89% after three years.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Diagnostic and Physiotherapy Approach for a Patient with Parsonage–Turner Syndrome—A Case Report

Wolny

Glibov

Granek

et al. 2023

Sensors

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Parsonage–Turner syndrome (PTS) is a rare neurological disorder that causes major diagnostic problems. This paper presents a case report of a patient with PTS and proposes a new physiotherapy program. Case description: a 23-year-old man presents a sudden severe pain of his right arm. The man is consulted by several doctors and physiotherapists. Three magnetic resonance imagings (MRI), a nerve conduction study (NCS), and needle electromyography (EMG) are performed. After 6 months, based on medical history, physical examination and ultrasound imaging (UI), the physiotherapist suggests PTS, which is confirmed by a neurologist. Intervention: due to the lack of physiotherapy treatment standards in PTS, we apply neurodynamic techniques. Outcomes: neurodynamic techniques are effective in reducing pain and paraesthesia, improving sensation, and reducing nerve swelling (assessed by UI), as well as improving manual dexterity and overall health status. Conclusions: the patient with PTS is challenging for making an accurate diagnosis. This study shows an important role for UI, which shows changes in the musculocutaneous nerve, despite the lack of abnormalities in the MRI, NCS, and EMG, and helps in making an accurate diagnosis. This report also confirms that physiotherapy based on neurodynamic techniques may have beneficial effects in PTS.

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Atypical Presentation of Parsonage-Turner Syndrome

Abstract: Ibrahim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 7 publications

References 10 publications

Anterior interosseous nerve lession and distal myoclonus revealing a parsonage turner syndrome associated with hashimoto thyroiditys

Anterior interosseous nerve lession and distal myoclonus revealing a parsonage turner syndrome associated with hashimoto thyroiditys

Painless Neuralgic Amyotrophy (Parsonage-Turner Syndrome) – A Case Report

Ultrasound Diagnostic and Physiotherapy Approach for a Patient with Parsonage–Turner Syndrome—A Case Report

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