Have you suddenly had unbearable pain in your shoulder? After a few days, maybe a few weeks, the pain subsides a little, but then your arm feels numb and weak? Then we're going to talk about something that might be important to you. This is a rare condition that scares a lot of people. We call it Parsonage-Turner Syndrome. Today, we'll talk about it in a simple way that you can understand.
Simply put, what is Parsonage-Turner Syndrome (PTS)?
Parsonage-Turner Syndrome (PTS), also sometimes called ``brachial neuritis'', is a condition involving the nervous system. It is characterized by sudden, severe pain in your shoulder and upper arm that seems to come on suddenly and for no apparent reason. This pain can last for days to weeks. Then the other problems begin. As the pain subsides, the muscles in your shoulder, arm, forearm, or hand begin to weaken. This weakness can last for months, or even years.
Imagine that we have a network of nerves that runs from our neck through our armpits to our arms. Just like the main switchboard in our house has wires running to every room, this network of nerves also sends signals to every part of our arms. We call this network of nerves the `(brachial plexus)`. In Parsonage-Turner Syndrome, this `(brachial plexus)` network of nerves is damaged. Especially the nerves that control movement are most damaged. That is why, after the pain, there is a feeling of numbness and weakness in the arms.
Because this condition is rare, doctors can sometimes confuse it with other common conditions. For example, it can be misdiagnosed as cervical radiculopathy or cervical spondylosis, as the symptoms are similar.
There are three stages of this disease.
This condition usually develops in three stages. Not everyone will have it this way, but this is the pattern that most people see.
Stage 1: Acute Pain Phase
This is the first stage. Suddenly, a sharp pain begins, often in one shoulder. This pain can last from a few days to a few weeks. It is generally said that the longer this painful period lasts, the longer it will take to fully recover.
Stage 2: Muscle weakness
After the pain gradually subsides, the second stage begins. This is where the muscles in the shoulder and arm begin to weaken. It becomes difficult to lift the arm or lift heavy objects. Over time, the muscles may atrophy due to disuse. This stage can last from six to 18 months, sometimes longer.
Stage 3: Recovery
This is the recovery phase. After a while, your muscles will slowly start to regain strength. Your hand will gradually return to normal function.
How common is this condition?
Parsonage-Turner Syndrome is actually a very rare condition. According to statistics, only about three people out of every hundred thousand develop this disease each year. So there's no need to worry about it every time your shoulder hurts.
Although it can develop at any age, it is more common in men . It is usually seen around the age of 40-45.
What exactly are the symptoms?
The two main symptoms are sudden, severe pain followed by muscle weakness. These symptoms can affect anywhere in your shoulder, upper arm, forearm, or hand.
The important thing is that in about 80% of cases, it affects only one arm (unilateral). And that's often the arm you use the most (dominant arm). In a small number of people, about 20%, it can affect both arms.
Let's look at how symptoms typically unfold.
| Symptom | Description |
|---|---|
| Sudden, severe pain | A sharp, unbearable pain, like a knife stabbing. This pain can be especially severe at night. This severe pain can last from a few hours to about four weeks. |
| Muscle weakness | After the pain subsides, the strength in the arm is lost. This is most often felt in the shoulder and upper arm. Sometimes the muscles of the chest or diaphragm can also be affected. |
| Other features | In addition to these main features, other things can be seen.
|
Why is this happening? What is the reason for this?
To be honest, researchers still haven't figured out the exact cause of this. But the main idea is that it's caused by an abnormal immune-mediated response in our body.
Simply put, when a germ, such as a virus or bacteria, enters our body, our immune system fights it off. But sometimes, during this fight, our immune system makes a mistake and instead attacks a healthy part of our own body, namely the ``brachial plexus`` nerve network. That's when these nerves are damaged and symptoms appear.
Often, this condition is preceded by a recent viral infection. For example:
- Coxsackie B virus
- HIV (Human Immunodeficiency Virus)
- Fifth disease (parvovirus B19)
- Mumps
But sometimes it can develop for no apparent reason. Very rarely, it can also be caused by a genetic condition called hereditary neuralgic amyotrophy.
Factors that increase the risk of this condition
It has been found that certain events or medical conditions may slightly increase the risk of developing Parsonage-Turner Syndrome.
- Recent surgery or anesthesia
- Connective tissue diseases - e.g. Ehlers-Danlos syndrome
- Autoimmune conditions - e.g. lupus
- An accident to the shoulder
- Exercises that put a lot of strain on the shoulders
- Some types of vaccines
- Pregnancy and childbirth
- Radiation therapy
- Lumbar puncture test
How does a doctor find this?
If you have these symptoms, you should first see your doctor. He or she will ask you about your symptoms and your medical history. Then, they will perform a physical exam to check your hand muscles, sensation, and reflexes. They will likely refer you to a neurologist, a doctor who specializes in nerve problems.
To confirm whether this is Parsonage-Turner Syndrome, your doctor may recommend a special test called an electromyography (EMG).
An EMG test is a test that sends very small electrical signals to your muscles and the nerves that control them to see how well those nerves and muscles are working. This can help determine if there is any nerve damage and where the damage is.
Additionally, imaging tests such as these may be performed to rule out other conditions and confirm the diagnosis:
- MRI (Magnetic Resonance Imaging) scan
- Nerve ultrasound test
- A CT (Computed Tomography) scan
Is there treatment? What can be done?
There is no specific treatment or cure for this yet. The best part is that this condition usually resolves on its own over time. However, early diagnosis and supportive treatment to control symptoms can speed up the healing process and achieve better results.
Your doctor will recommend various treatments to manage your symptoms.
During the acute phase
- Painkillers: Things like common painkillers (NSAIDs).
- Oral Corticosteroids: A type of medication given to control inflammation of the nerves and the activity of the immune system.
- Arm immobilization: Give your arm a rest, and you may be asked to use something like a shoulder stabilizer.
- TENS (Transcutaneous Electrical Nerve Stimulation): A method of controlling pain by sending small electrical signals through the skin.
- Acupuncture: Some people also find pain relief from this.
After the pain subsides
- Physical Therapy: This is extremely important . A physical therapist will teach you exercises and stretches to help strengthen damaged muscles, keep joints from getting stiff, and regain function in your hand.
- Special medications for nerve pain: Some people may experience pain that is similar to nerve inflammation, even though the pain has subsided. In such cases, your doctor may prescribe special medications such as gabapentin, carbamazepine, or amitriptyline.
In very severe cases, when no other treatment is effective, surgery (nerve grafting or tendon transfers) may be considered. However, this is very rare.
What will the future hold with this situation? (Prognosis)
The course of this condition can vary from person to person. For some people, it happens only once in their life and they recover completely. For others, they may continue to have some degree of weakness or pain. For a small number of people, it can recur.
According to research, about 89% of people who manage their symptoms and receive proper physical therapy will fully recover within three years. Of those, 75% will recover within two years, and 36% will recover within the first year.
That means, although it takes time to recover from this, the majority of people recover. The most important thing is to be patient and follow the doctor's instructions during treatment.
Take-Home Message
- Parsonage-Turner Syndrome (PTS) is a rare neurological condition that causes sudden, severe pain in the shoulder and arm, followed by muscle weakness.
- Although the exact cause of this has not been found, it is believed to be caused by an abnormal function of the immune system.
- If you suddenly experience severe shoulder pain, don't ignore it and see a doctor immediately. A quick diagnosis is very important.
- Although there is no specific cure for this, symptoms can be managed with supportive treatments such as pain management and physical therapy.
- It can take time to heal. It can take months to years. So it's important to be patient and positive about your treatment. Most people make a full recovery over time.
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