What are the other Names for this Condition? (Also known as/Synonyms)

• Brachial Plexus Neuritis
• Idiopathic Brachial Plexus Neuropathy
• PTS (Parsonage-Turner Syndrome)

What is Parsonage-Turner Syndrome? (Definition/Background Information)

• Parsonage-Turner Syndrome (PTS) is characterized by possible autoimmune inflammation affecting the brachial plexus (part of the neck, shoulders, arms, and hands nerves) of unknown causation
• The exact cause of Parsonage-Turner Syndrome is not well-understood. PTS is considered to be caused by a variety of factors that may be genetic, immunologic, and/or environmental in nature
• PTS is thought to be triggered by the body’s immune system through triggers such as surgery involving the brachial plexus, autoimmune disorders, childbirth in some women, and infections. It is researched that some individuals are more susceptible than others due to some genetic predisposition
• The signs and symptoms of Parsonage-Turner Syndrome include a gradual onset of shoulder pain that may be acute and severe. The pain may spread to the arms or neck and can get worse during night. 1 in 4 individuals may have several episodes of the symptoms
• Severe cases can result in complications including shortening of muscles, mal-alignment of the upper body, partial vocal cord paralysis, and even breathing difficulties
• A diagnosis of Parsonage-Turner Syndrome can be made through physical examinations, muscle and nerve conduction studies, and radiological imaging studies performed on the upper body
• A symptomatic treatment for Parsonage-Turner Syndrome is offered to address the pain and other symptoms. In some cases, surgery (nerve grafting or tendon transfer procedure) may be necessary
• The prognosis of Parsonage-Turner Syndrome is based on the severity of the signs and symptoms. However, in a majority of the individuals, the prognosis is good; although, around 25% of the individuals may have recurring conditions that may affect the quality of life

Who gets Parsonage-Turner Syndrome? (Age and Sex Distribution)

• Parsonage-Turner Syndrome is most common in middle-aged or young adults; however, it has been reported in children and the elderly
• Males are more likely to be affected by PTS than females
• All races and ethnic groups can be affected

What are the Risk Factors for Parsonage-Turner Syndrome? (Predisposing Factors)

The risk factors for Parsonage-Turner Syndrome include several events which can trigger an immune response in the body:

• Recent immunization
• Surgery on the brachial plexus
• Extreme and strenuous exercise
• Trauma to the head and neck region, or to the shoulder region
• Anesthesia
• Rheumatic diseases
• Systemic lupus erythematosus (SLE)
• Temporal arteritis
• Polyarteritis nodosa
• Childbirth can trigger Parsonage-Turner Syndrome in some women
• Bacterial or parasitic infection
• Individuals may have a genetic predisposition to the disorder. This means that individuals with such a genetic susceptibility are more likely to get PTS in presence of the risk factors, compared to individuals without such genetic predispositions

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others. 

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Parsonage-Turner Syndrome? (Etiology)

The cause of Parsonage-Turner Syndrome is not clearly known or understood. It is believed to be an inflammatory response in the brachial plexus to various environmental, immunologic, and genetic factors. 

The triggers may include the following factors:

• Recent immunization
• Surgery on the brachial plexus
• Extreme strenuous exercise
• Trauma to the head and neck or shoulder region
• Anesthesia
• Rheumatic diseases
• Lupus
• Temporal arteritis
• Polyarteritis nodosa
• Childbirth can trigger Parsonage-Turner Syndrome in women
• Bacterial or parasitic infection

What are the Signs and Symptoms of Parsonage-Turner Syndrome?

The signs and symptoms of Parsonage-Turner Syndrome often vary from one individual to another, but may include:

• Sudden or gradual onset of pain in one shoulder, which is often followed by a rapid increase in pain
• The pain may also radiate to the neck, arm, or hand
• Pain is commonly continuous and worse at night or in the evening
• During the acute phase, the pain may be debilitating
• Over time the pain usually lessens, especially when the arm is at rest
• Chronic pain is less severe and may last up to a year or longer
• While a majority of individuals may only have one episode of symptoms, others (about 25%) may have recurrent episodes of pain that may diminish or spread (varying on a case by case basis)
• Sensitivity may persist during movement due to nerve damage: Any movement may trigger an increase in signs and symptoms due to underlying nerve damage (exaggerated response to stimulus or hypersensitivity)
• After days or weeks following the onset of symptoms, pain is replaced by muscle loss:
  • The resulting weakness may be barely noticeable or lead to near paralysis
  • Weakness is relative to the number of nerves affected by the condition
• Reduced reflexes
• Numbness in or around affected areas
• Sensation of tickling, burning, or pricking on the skin
• Light touch may become painful
• Blood vessel damage

How is Parsonage-Turner Syndrome Diagnosed?

A diagnosis of Parsonage-Turner Syndrome is made by the following observations and tests:

• A careful physical examination and assessment of medical history
• Electromyography - to test muscular response to nerve signals
• Magnetic resonance imaging (MRI) studies can help detect inflammation and muscle atrophy
• Muscle conduction studies and nerve conduction studies (assessing the ability of specific peripheral nerves to relay information to the brain) can be helpful in arriving at a diagnosis
• X-ray may be used to rule out other causes of shoulder pain

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Parsonage-Turner Syndrome?

The possible complications of Parsonage-Turner Syndrome may include:

• Arms, shoulders, or hands may shift in position: Because of the muscle atrophy of the shoulder and other regions, it may result in mal-alignment of the upper body. This can increase the risk of impingement (connective tissue rubbing against the shoulder blade) or subluxation (partial dislocation) in the  affected individuals
• Contractures (shortening of muscles or tendons), which can reduce mobility and cause pain
• Lower back nerves can be affected causing pain, reduced sensation, tingling, or prickling sensation
• Shortness of breath, due to damage to the nerve controlling the diaphragm
• Weakness or partial paralysis of the vocal cords, resulting in hoarseness or a soft voice
• Although it is rare, the cranial or facial nerves may be affected
• Red or purple coloration on the hands which may appear spotted
• Swelling of the affected limbs
• Excessive sweating (unresponsiveness to temperature)

How is Parsonage-Turner Syndrome Treated?

The treatment for Parsonage-Turner Syndrome is directed towards the symptoms and may include:

• Pain medications (analgesics); opiates
• Non-steroidal anti-inflammatory drugs; oral corticosteroids
• Co-analgesics for the chronic phase (specifically to treat nerve pain)
• Application of heat or cold to the affected shoulder/chest/arm area
• Rest and reduction of activity
• Transcutaneous nerve stimulation to control pain
• Surgery:
  • Nerve grafting: This procedure involves taking part of a nerve from one part of the body to repair a damaged nerve
  • Tendon transfer procedure (following loss of muscle function)
• Physical therapy

How can Parsonage-Turner Syndrome be Prevented?

The prevention of Parsonage-Turner Syndrome may include addressing the risk factors, such as:

• Avoiding extremely demanding physical exercise or activities that could lead to trauma
• Genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help in understanding the risks better during pregnancy
• If there is a family history of the condition, then genetic counseling will help assess risks, before planning for a child

What is the Prognosis of Parsonage-Turner Syndrome? (Outcomes/Resolutions)

• The prognosis for Parsonage-Turner Syndrome is generally good. Most individuals are known to regain 70-90% of their former strength in the affected areas
• About 25% of individuals will have a recurring bout later on in life
• It has been reported, although rarely, that affected individuals may be left with a severe disability that can impact their quality of life
• As with many disorders, it is important that an early diagnosis be followed by effective treatment, which can help avoid the complications associated with PTS

Additional and Relevant Useful Information for Parsonage-Turner Syndrome:

Dr. Parsonage and Dr. Turner first characterized the condition in patients back in the 1940’s, originally referring to it as Amyotrophic Neuralgia.