Cervical Radiculopathy vs Parsonage–Turner Syndrome: A Case Report

Abstract

A 42-year-old recreational cyclist presented with a 3-month history of right-sided neck pain. The patient experienced pain radiating to the right periscapular region and paresthesias in digits 1-3. The onset of the pain was sudden. She described the pain as intermittent and sharp, ranging from 8-10/10 on numeric pain rating scale. The pain was worse at nighttime, often so severe that it would wake her from sleep. She also noted severe headaches and right upper extremity numbness and weakness. She had visited the emergency room twice, both times being admitted to a neurology service because of the severe nature of the pain and what was described as atypical hemiplegia and migraines. A CT scan of the head and cervical spine and an MRI of the cervical spine were normal. The patient was discharged on pain medication, which included prednisone, depakote, zoloft, motrin, and topamax. There was no history of trauma, falls, or any inciting events. She had no history of bowel or bladder incontinence, recent travel, or fever and chills. Her medical history was significant for migraines, right carpal tunnel syndrome, and depression. She was taking lexapro and clonazepam for depression.Physical examination revealed mild limited cervical range of motion with end range axial pain with flexion, extension, and lateral rotation. Spurling maneuver was positive on the right side eliciting pain in digits 1 and 2. Active and passive range of motion of the right shoulder was minimally limited compared to the left (asymptomatic) side. Additional findings included medial winging of the right scapula and mild weakness (4+/5) of the right triceps. Muscle strength throughout the rest of the upper extremities was 5/5. The rest of the physical examination revealed normal muscle bulk and tone, normal sensation, symmetric upper extremity reflexes, and negative Hawkins_, Neer_s, Roos_, Wright_s, and Adson_s provocative tests.Clinical evaluation at this point was suggestive of Parsonage-Turner syndrome vs a cervical radiculopathy, although a broader differential diagnosis was considered (Fig. 1). Electrodiagnostic studies were performed and showed evidence of severe denervation (2+ positive sharp waves and fibs) corresponding to muscles of the right C7 myotome and including the paraspinal muscles, consistent with a right C7 radiculopathy (Fig. 2). Motor unit recruitment was reduced in the involved muscles and there were no polyphasic potentials. An MRI of the cervical spine was repeated and revealed mid to lower cervical spondylosis, moderate left-sided C5/6 foraminal stenosis, and mild right-sided C6/7 foraminal stenosis (Fig. 3). Because the MRI findings did not demonstrate significant nerve root compression, the patient was diagnosed with Parsonage-Turner syndrome and Lyrica was prescribed. Over the next 6 weeks the patient_s symptoms improved but then suddenly worsened.The patient returned for follow-up with complaints of recurrent right neck pain and right upper extremity weakness. Neck range of motion was now normal and Spurling_s maneuve...

Musculocutaneous Neuropathy: Case Report and Discussion

“…Although [14,17]. The suprascapular, long thoracic, and axillary nerves are the most commonly involved peripheral nerves with the musculocutaneous, anterior interosseous, ulnar, and median nerves also being occasionally involved [14,[17][18][19][20][21][22]. The exact etiology of the disorder is not fully understood, but 25% of cases occur after a viral infection, and 15% occur after immunization [14].…”

“…Parsonage Turner syndrome has also been seen after exercise and surgery [14,23,24]. Diagnosis of LACN entrapment depends on a good history and physical examination with knowledge of the nerve pathway within the arm.…”

Parsonage-Turner Syndrome

“…Other causes of brachial plexopathies such as thoracic outlet syndrome may present with less acute and severe pain and should also be entertained [33,36,54,55,82]. The classic skin lesion associated with shingles will usually be identified in cases of postherpetic neuralgia, making this diagnosis fairly obvious; however, cases of shingles can present without rash, making the diagnosis in these cases more elusive [28]. Patients with cervical radiculopathies will commonly have a positive Spurling maneuver [72].…”

Three‐tesla magnetic resonance neurography of the brachial plexus in cervical radiculopathy

“…Indeed, the majority of our patients had engaged in manual labor before the onset of their symptoms. In fact, clinical presentation of NA with cervical spondylosis may sometimes be indistinguishable from cervical radiculopathy . Moreover, steroid treatment has been reported to be effective in improving acute pain in both disorders .…”