Parsonage-Turner Syndrome : Physiotherapy Treatment

Parsonage-Turner Syndrome

Parsonage-Turner Syndrome (PTS) also known as idiopathic brachial plexopathy or neuralgic amyotrophy, is a rare disorder which includes complex set of symptoms like sudden onset of unilateral shoulder pain, further neurologic deficits occur in a progressive manner which includes dysesthesia and numbness. The most common involved nerves are suprascapular and axillary nerves.

 

Phases of Parsonage Turner Syndrome

Onset Phase: 

This phase begins with sudden and severe shoulder or arm pain, often described as sharp, stabbing, or burning. The pain can be debilitating and might come on abruptly, sometimes following a viral illness or vaccination.

Acute or Peak Phase: 

During this phase, the pain may reach its peak intensity and persist for a few days to several weeks. Alongside the pain, weakness and muscle atrophy (wasting) in the affected shoulder or arm muscles may develop. Numbness, tingling, or loss of sensation might also occur.

Recovery Phase: 

Improvement typically starts within a few weeks to months after the onset of symptoms. Recovery may be gradual, and the extent of recovery can vary widely among individuals. Some people may regain full function, while others may have residual weakness or ongoing discomfort. 

 

These phases can vary in duration and intensity from person to person. Rehabilitation and physical therapy are often recommended during the recovery phase to help regain strength and function in the affected muscles.

 

Causes of Parsonage Turner Syndrome

• Viral Infections
• Autoimmune Response - immune-mediated brachial nerve injury
• Genetic Predisposition - hereditary neuralgic amyotrophy
• Trauma or Injury - mechanical injury from traction
• Post-surgical
• Vaccinations

 

Parsonage Turner Syndrome Symptoms

• Sudden Onset Shoulder Pain - often the initial symptom, pain can be intense, lasts longer in men than female and may radiate down the arm
• Muscle Weakness - lifting objects or reaching overhead are difficult
• Muscle atrophy -  supraspinatus, infraspinatus, deltoid, biceps, trapezius, serratus anterior, pronator teres, teres minor.
• Numbness or Tingling - sensory symptoms are usually not present in over one-third of patients
• Limited Range of Motion
• Shoulder Instability
• Recurrent laryngeal nerve involvement with hereditary neuralgic amyotrophy
• Paresthesia
• Allodynia

 

Parsonage Turner Syndrome Diagnosis

• Blood Tests -  to rule out other conditions that can cause similar symptoms, such as autoimmune disorders
• Nerve Biopsy – shows perineural thickening, neovascularization, and focal fiber loss
• High resolution ultrasound - inflammatory of peripheral nerves, segmental swelling, hourglass constrictions, and torsions, which are very specific for PTS
• MRI - The cervical spine MRI was only significant for mild to moderate vertebral degeneration
• X-ray - thoracic or neck masses compressing the brachial plexus, fractures, dislocations, or structural issues
• Nerve conduction studies - absent sensory nerve action potential, reduced compound motor action potentials, and prolonged F response in severe disease
• magnetic resonance neurography

 

Differential Diagnosis

• Rotator Cuff Injuries
• Cervical Radiculopathy
• Thoracic Outlet Syndrome
• Frozen Shoulder (Adhesive Capsulitis)
• Brachial Plexus Injury
• Peripheral Neuropathy
• Osteoarthritis
• Bursitis
• Tendinitis
• Multiple sclerosis or
• Guillain-Barré syndrome
• Mononeuritis multiplex
• Entrapment neuropathy
• Complex regional pain syndrome
• Progressive muscular atrophy
• Lyme disease
• Poliomyelitis
• Vertebral fracture
• Cervical spondylosis with referred pain

 

Parsonage Turner Syndrome Physiotherapy Treatment

Pain Management through Electrotherapy

• Cryotherapy
• Heat therapy
• Transcutaneous Electrical Nerve Stimulation (TENS)

 

Range of Motion (ROM) Exercises:

Physiotherapist can customize exercises according to the involved muscle. Some exercises include:

• pendulum exercises
• passive or assisted ROM
• gentle movements to restore mobility

 

Strengthening Exercises:

Once pain subsides and range of motion improves, targeted strengthening exercises are prescribed to rebuild muscle strength and endurance in the affected shoulder and arm muscles. Physiotherapist should check the status of muscle i.e. it is innervated or denervated.

• thera band exercises
• isometric exercises
• gradually progressing to more dynamic movements

 

Functional exercises are incorporated to simulate everyday activities along with educating patients on proper posture and body mechanics, to prevent unnecessary stress on the shoulder and arm, reducing the risk of further injury or strain.

 

Neuromuscular Re-education:

This involves exercises and techniques to improve coordination, proprioception, and motor control in the affected muscles. These techniques are helpful in reducing pain, paresthesia, improving sensation, and reducing nerve swelling.

These technique involves a series of controlled movements that aim to gently stretch and mobilize the nerve without causing further irritation.

 

• Radial nerve neurodynamic technique

Neurodynamic sequence

1. arm extension
2. arm adduction to 45°
3. arm internal rotation
4. wrist and fingers flexion
5. forearm pronation
6. elbow extension

 

• Median nerve neurodynamic technique

Neurodynamic sequence

1. arm adduction to 90°
2. arm external rotation
3. wrist and fingers extension
4. forearm supination
5. elbow extension

 

• Ulnar nerve neurodynamic technique

Neurodynamic sequence

1. arm adduction to 90°
2. arm internal rotation
3. wrist and fingers extension
4. forearm pronation
5. elbow extension

 

• Musculocutaneous nerve neurodynamic technique

Neurodynamic sequence

1. arm extension
2. arm adduction to 45°
3. arm internal rotation
4. wrist ulnar deviation
5. thumb flexion
6. elbow extension

 

Frequently Asked Questions

What does parsonage turner syndrome feel like?

Experiences of Parsonage-Turner syndrome vary from individual to individual but commonly it is describes as a sudden onset of shoulder pain leading to muscle weakness and functional limitations. Physiotherapy, is crucial for regaining strength, improving range of motion, and restoring functionality. This process can be lengthy and may require patience and persistence.

 

Does parsonage turner syndrome occur after COVID vaccine?

PTS can occur post-COVID-19 vaccination  if he experiences symptoms like shoulder pain,  develops weakness or sensory changes in the upper extremity. but if the shoulder pain continues differential diagnosis should be considered.

 

Is parsonage turner syndrome and brachial plexitis same?

Parsonage-Turner syndrome is also known as brachial neuritis or brachial plexitis. This condition affects the brachial plexus, which is a network of nerves that sends signals from the spine to the shoulder, arm, and hand.

 

Is parsonage turner syndrome a disability?

Calling parsonage syndrome a disability depends on various factor like severity of the symptoms and their impact on an individual's daily life, work, and functionality.

For some individuals, the acute phase of Parsonage-Turner syndrome can be extremely debilitating, causing significant pain and weakness that affect their ability to work, perform routine tasks, or engage in activities they previously enjoyed. During this phase, they might qualify for temporary disability benefits or accommodations to help manage their condition.

Recovery from Parsonage-Turner syndrome can vary widely among individuals. While some may experience a full recovery, others might have residual weakness or limitations that persist for an extended period, impacting their ability to perform certain activities or work-related tasks.