Postsurgical Brachial Neuritis After Orthognathic Surgery: A Case Report

Huang, Yung-Chuan; Wang, Han-Cheng; Tsai, Yuh-Feng; Chang, Shu‐Fang; Hsu, Wei-Chih

doi:10.1016/j.joms.2005.05.306

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…In these cases, PTS typically occurs in the perioperative timeframe during acute postoperative recovery and, in some cases, rehabilitation. The surgeries reported include a variety of orthopedic procedures, coronary artery bypass surgery, hysteroscopy, and oral surgery [3,12,16,24,30,39,48,69]. Several mechanisms have been postulated for the onset of this condition in such situations.…”

Section: Association With Surgical Proceduresmentioning

confidence: 99%

“…Injury to the brachial plexus can also occur in surgical situations when the arms are overabducted in a prone or supine position. However, this theory of injury seems unlikely in the face of mounting evidence that PTS also occurs in surgical procedures that involve little to no traction or compression injury to the brachial plexus [24,39,48].…”

Section: Association With Surgical Proceduresmentioning

confidence: 99%

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Parsonage-Turner Syndrome

Feinberg

Radecki

2010

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

154

171

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Parsonage-Turner Syndrome (PTS), also referred to as idiopathic brachial plexopathy or neuralgic amyotrophy, is a rare disorder consisting of a complex constellation of symptoms with abrupt onset of shoulder pain, usually unilaterally, followed by progressive neurologic deficits of motor weakness, dysesthesias, and numbness. Although the etiology of the syndrome is unclear, it is reported in various clinical situations, including postoperatively, postinfectious, posttraumatic, and postvaccination. The identification of the syndrome in the postoperative patient remains a challenge as symptoms may easily be attributed to sequelae of surgical positioning, postoperative recovery, or postanesthetic block pain. The purpose of this review is to bring forth salient, identifiable factors which may assist the surgical clinician in identifying the condition sooner. An early and proper diagnosis affords the opportunity to treat the patient accordingly and to the satisfaction of both surgeon and patient.

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Section: Association With Surgical Proceduresmentioning

confidence: 99%

Section: Association With Surgical Proceduresmentioning

confidence: 99%

Parsonage-Turner Syndrome

Feinberg

Radecki

2010

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

154

171

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“…Myriad single cases and short series of PSPTS have been reported in the literature spanning a wide array of surgical procedures: orthopedic (knee arthrotomy/replacement, cervical spine decompression, hip replacement), gynecologic (vaginal hysterectomy, hysteroscopy, pubovaginal sling), and abdominal (appendectomy) (Table 5) [5,[7][8][9]13,15,[18][19][20][21][22][23][24][25]. Squintani and colleagues report a 66-year-old man who underwent a left carpal tunnel release and experienced aching of the wrist and bilateral weakness of the thumb and index fingers several days later [24].…”

Section: Discussionmentioning

confidence: 99%

“…Postsurgical PTS (PSPTS) is particularly important as it poses not only diagnostic and therapeutic challenges but also ushers in medicolegal issues. Several single cases and short series of PSPTS have been reported in the literature [5,[7][8][9]13,15,[18][19][20][21][22][23][24][25], however, a detailed analysis of a large series is not available. The goal of the present study is to provide better insight into the clinical spectrum of nerve involvement in PSPTS and the type of preceding surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Clinical Spectrum of Postsurgical Parsonage-Turner Syndrome: A Perspective From an Electrodiagnostic Laboratory

Iyer¹,

Shields²,

Shields³

2023

Cureus

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Background: Parsonage-Turner syndrome (PTS) is an underdiagnosed disorder characterized by the acute onset of severe pain in the shoulder/scapula/arm followed by muscle weakness/numbness in the distribution of nerves derived from the brachial plexus (BP). Surgical procedures are one of several antecedent events of PTS. This study describes the clinical spectrum of postsurgical Parsonage-Turner syndrome (PSPTS) in a large cohort of patients. Materials and methods: Charts of patients diagnosed with PTS during a 16-year (2006-2022) retrospective review were analyzed to identify cases of PSPTS. The clinical criteria for PSPTS included the new onset of severe pain two days to four weeks after a surgical procedure followed by weakness of muscles innervated by one or more nerves arising from the BP. EDX criteria consist of denervation localized to branches of the BP. PSPTS cases were subdivided into two categories: definite PSPTS (surgery at a remote site) and probable PSPTS (surgery of the ipsilateral upper extremity or the cervical spine). Results: Of 202 patients (204 episodes) diagnosed with PTS, 111 (54%) were idiopathic and 61 (30%) were PSPTS. Of the 61 PSPTS episodes, 26 were definite and 35 were probable PSPTS. The anterior interosseous nerve (AIN) was most affected, followed by the posterior interosseous (PIN), and suprascapular nerve. Conclusion: In this series, surgery was the most commonly recognized antecedent event for PTS, and the AIN and PIN were the most frequent nerves affected. Surgeons should consider PTS in patients who develop postoperative severe shoulder pain and weakness of muscles innervated by the BP.

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“…The association between oral surgery and PTS is postulated to be either because of mechanical injury from traction or inadequate head and neck position, or an immune-mediated brachial nerve injury in a genetically predisposed person. 11 Following a precipitating event, there is a multi-focal inflammation of the affected nerves. The immune pathogenesis is evidenced by the perineural thickening, neovascularisation, and focal fibre loss seen in nerve biopsies.…”

Section: Pathophysiologymentioning

confidence: 99%

Successful Management of Parsonage–Turner Syndrome with Steroids in the Post-acute Weakness Phase: A Case Report

Butt¹,

Agadi

Butt³

et al. 2021

EMJ Neurol

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Introduction: Parsonage–Turner Syndrome (PTS) is a rare disease of the brachial plexus of unclear aetiology. The limited data available typically describes involvement of branches of brachial nerves. The authors present a case of PTS with a rare combination of unilateral brachial plexus, phrenic nerve, and recurrent laryngeal nerve injuries. They also highlight successful treatment with pharmacological intervention despite several months’ delay in diagnosis. The 35-year-old female presented with acute onset of severe left shoulder pain followed by severe progressive weakness of the left shoulder muscles, progressive weakness of her voice, nasal regurgitation of fluids, paroxysmal bouts of coughing, and exertional dyspnoea at rest. The symptoms remained undiagnosed for about 10 months. A clinical diagnosis of exclusion of PTS was finally made, and treatment with steroids, neurotropic drugs, and physiotherapy was started. The patient has recovered significantly since then and continues to improve. Conclusion: The authors presented a case of PTS with a rare combination of brachial plexus, recurrent laryngeal nerve, and phrenic nerve injuries. This case was also remarkable for the significant improvement in her symptoms with treatment, despite the delay in diagnosis. This bears evidence that steroids and adjuvant therapy is useful even months after onset of the disease.

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Postsurgical Brachial Neuritis After Orthognathic Surgery: A Case Report

Cited by 5 publications

References 12 publications

Parsonage-Turner Syndrome

Parsonage-Turner Syndrome

Clinical Spectrum of Postsurgical Parsonage-Turner Syndrome: A Perspective From an Electrodiagnostic Laboratory

Successful Management of Parsonage–Turner Syndrome with Steroids in the Post-acute Weakness Phase: A Case Report

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