What is Parsonage-Turner Syndrome? Do you experience sudden pain in your shoulder and numbness in your arm?

Have you ever woken up in the morning, or at any time of the day, and suddenly felt a sharp pain in your shoulder area, along with numbness and weakness in your arm? This may have been going on for a few days or weeks, and then your muscles slowly started to weaken. If you have had a similar experience, it is very important to be aware of this condition called Parsonage-Turner Syndrome, which we are going to talk about today.

What exactly is Parsonage-Turner Syndrome?

Simply put, Parsonage-Turner Syndrome , sometimes called Brachial Neuritis , is a condition involving the nervous system. What happens is that you suddenly experience a sudden, unimaginable, severe pain in your shoulder and upper arm. This pain can last for days to weeks. That's when the real problem begins. As the pain subsides, you start to feel weakness or numbness in the muscles of your shoulder, arm, forearm, or fingers. This weakness can last for months. Think about it, there is a network of nerves that runs from the spine in your neck, through your neck, through your armpits, and down your arms. That's what we call the brachial plexus . It's like a system of electrical wires. Parsonage-Turner syndrome is a condition in which the brachial plexus is damaged. It specifically affects the motor nerves that control movement and their axons . This is what causes muscle weakness. PTS is a rare condition. That's why doctors sometimes confuse it with cervical radiculopathy , a condition that causes nerve compression in the neck, or cervical spondylosis , which is a very common condition. The symptoms are very similar. It's named Parsonage-Turner after two British neurologists, Maurice Parsonage and John Turner, who first described the condition in 1948. This is called by several other names:

• Brachial neuritis
• Brachial plexus neuritis
• Brachial plexus neuropathy
• Idiopathic brachial plexus neuropathy
• Neuralgic amyotrophy

What are the stages of this condition?

There are generally three main stages of Parsonage-Turner syndrome. Let's see what they are. 1. First stage (acute pain phase):This is a sudden, severe pain that is unimaginably severe . Most often, it affects one shoulder. This pain can last from a few days to a few weeks. It is generally said that the longer this pain phase lasts, the longer it will take to heal. 2. Second stage: After the pain gradually subsides, you will begin to feel weakness in your muscles. Especially the muscles around your shoulder and arm become weak. This can sometimes lead to muscle wasting, or atrophy . This second stage usually lasts between 6 and 18 months. But for some people it can last even longer. 3. Third stage: After some time, your muscles regain strength and begin to function normally. This is the healing stage.

How common is this condition?

In fact, Parsonage-Turner syndrome (brachial neuritis) is a very rare condition. It is said that only about three people out of a hundred thousand develop this disease each year. It can develop in anyone of any age. However, it is seen slightly more in men . The average age of onset of this disease is about 41 years.

What are the symptoms of Parsonage-Turner syndrome?

The two main symptoms of this condition are sudden pain and subsequent muscle weakness . These can affect these areas of your:

• Shoulder
• Upper arm (upper part of the hand)
• Forehead (middle part of the hand)
• Hand (hand and fingers)

Most often, about 80% of the time, it affects only one arm (unilateral). It usually affects the arm/side you use the most. But in about 20% of cases, it can affect both arms (bilateral). Very rarely, it affects the lower trunk and legs. Most of the time, the pain comes on suddenly. It feels like a sharp, unbearable pain , especially at night. This severe pain can last from a few hours to four weeks. After the pain goes away, the muscles in your affected arm begin to weaken. You will most likely feel muscle weakness in your shoulder or upper arm. But it can also affect your forearm and hand. Sometimes, the weakness can affect the muscles in your chest or diaphragm (the muscle that separates your chest from your abdomen). When muscles become weak, over time, muscle tissue atrophies. The severity of these symptoms can vary greatly from person to person. This is because the nerves affected by PTS vary from person to person. There may be several other symptoms:

• In the affected handProblems with reflexes.
• Abnormal sensations in the hand, known as paresthesia , or numbness. This can feel like a tickling, prickling, or burning sensation.
• Partial shoulder dislocation .
• Abnormal range of motion in the affected joints.
• A condition called winged scapula (in which the shoulder blade protrudes backward, like a wing).
• Shortening of the muscles or tendons in the affected arm.
• Red, purple, or blotchy hands due to decreased blood circulation .
• Swelling of the hands .
• Difficulty breathing (dyspnea) . This is very rare.

Why does Parsonage-Turner syndrome occur?

In fact, researchers still don't know the exact cause of Parsonage-Turner syndrome. They think that an abnormal reaction of our body's immune system, called an immune -mediated response, is the main cause. There are two theories about this. 1. A viral, bacterial, or parasitic infection directly affects your brachial plexus, causing symptoms. 2. When your immune system fights these bacteria, viruses, or antigens , it damages your brachial plexus as a side effect. Most often, the main cause of this condition is a recent viral infection . The following viral diseases have been identified as being most likely to be involved:

• Coxsackie B virus : This can cause several conditions, including pneumonia , gastrointestinal illness, myocarditis (inflammation of the heart muscle), aseptic meningitis (a type of brain infection), encephalitis (inflammation of the brain), and viral hepatitis (inflammation of the liver).
• HIV (Human Immunodeficiency Virus) .
• Fifth disease (parvovirus B19) .
• Mumps .
• Smallpox (variola major and minor) .

Sometimes, doctors can't find a specific cause. Very rarely, Parsonage-Turner syndrome is a genetic/inherited condition.It can also be caused by hereditary neuralgic amyotrophy.

What are the risk factors that contribute to this condition?

Researchers believe that certain medical conditions and situations may increase your risk of developing Parsonage-Turner syndrome. Here are some of them:

• Recent surgery and/or anesthesia .
• Connective tissue diseases, for example, conditions like Ehlers-Danlos syndrome .
• Autoimmune diseases, such as lupus (systemic lupus erythematosus - SLE) , temporal arteritis , and polyarteritis nodosa .
• A traumatic shoulder injury .
• Intense exercise that strains the shoulders.
• Getting vaccines/immunizations (this is very rare, but there have been some reports).
• Pregnancy and childbirth .
• Receiving radiation therapy .
• Lumbar puncture (spinal tap) , which means taking fluid from the spine.
• Injecting contrast dye for an imaging test.

How is Parsonage-Turner syndrome diagnosed?

When you see a doctor, they will ask you about your symptoms and medical history. They will then do a physical exam. They will check the strength, reflexes, and sensation of your arm muscles. You may also be referred to a neurologist . If your doctor thinks you have Parsonage-Turner syndrome, they may recommend an EMG (electromyography) test. This is used to assess the health and function of your skeletal muscles and the nerves that control them. In addition, the following imaging tests may be done to confirm the diagnosis or rule out other conditions:

• MRI (magnetic resonance imaging) scan .
• Nerve ultrasound test .
• CT (computed tomography) scan .

What are the treatments for this?

To be honest, there is no specific treatment or cure for PTS. Most of the time, it will go away on its own over time. However, it is important to diagnose the condition early.If you start treatment that helps control your symptoms, your prognosis can be greatly improved. Your doctor will recommend a variety of treatments to help manage your symptoms. You may also be referred to a team of specialists to develop a treatment plan. This team may include:

• Primary care physicians (PCPs)
• Orthopedists
• Neurologists
• Neuromuscular disease specialists
• Physical therapists

Treatments given during the acute pain phase may include:

• Painkillers, for example NSAIDs (non-steroidal anti-inflammatory drugs) that can be purchased at the pharmacy.
• Oral corticosteroids .
• Avoid using the arm too much, or immobilize the arm using a shoulder stabilizer.
• Transcutaneous electrical nerve stimulation (TENS) is an electrical nerve stimulation therapy.
• Acupuncture .

After the acute pain phase is over, your doctor will likely recommend these treatments:

• Physical therapy : A physical therapist will teach you stretching and strengthening exercises to help you regain control of the affected muscles and joints.
• Co-analgesics: These are medications that are specifically used to treat nerve pain. Examples include gabapentin , carbamazepine, and amitriptyline .

In very severe cases, if nothing else relieves your symptoms, your doctor may recommend surgery . These procedures may include nerve grafting or tendon transfers .

Can this be prevented from happening?

Since researchers still don't know the exact cause of PTS, there's really nothing you can do to prevent it. However, since certain viruses can trigger it, staying as healthy as possible can help reduce your risk of developing it.

What is the prognosis for this condition?

The outlook for recovery from PTS can vary from person to person.Some people experience PTS only once and fully recover from the affected area. Others may have ongoing weakness and pain. Some people may also experience PTS more than once (recurrence). There are some factors that may reduce the likelihood of recovery :

• The pain persists for three months and the muscles do not recover.
• If PTS has affected your lower torso/abdomen .
• If the cause is a hereditary condition , the tendency for the disease to recur is very high in such cases.

According to one study, 89% of PTS patients who received symptom management and physical therapy recovered within three years. Of those, about 75% recovered within two years, and 36% recovered within the first year. Recent studies show that many people may continue to have pain and some functional problems. However, full recovery of strength is possible , although it can take up to eight years.

When should I see a doctor?

It is very important to diagnose Parsonage-Turner syndrome early and accurately . If you have pain, especially if it is sudden and severe , be sure to see a doctor.

What questions should you ask the doctor?

If you want to know more about this condition, you can ask your doctor questions like these:

• Why did I develop Parsonage-Turner syndrome?
• What kind of specialists should I see?
• What kind of painkillers do you recommend?
• How should I take care of myself at home?
• How quickly do you think I will recover?
• What kind of treatment do you recommend?
• How do I know if this PTS condition is getting better or worse?

Finally, things to remember (Take-Home Message)

Sudden, severe pain can be a scary thing. It's your body's way of telling you, "Something is wrong." That's why it's important to see a doctor as soon as possible. There are many treatments that can help manage the symptoms of Parsonage-Turner syndrome (PTS) and possibly speed up your recovery. If you have any questions about PTS, don't be afraid to ask your doctor. They're there to help you. Remember that you're not alone, there are other people going through this, and there are doctors who can help .