Role of Exploration and Nerve Transfer in Restoration of Shoulder Function in Parsonage-Turner Syndrome
Keywords:
Parsonage-Turner syndrome, nerve transfer, neuralgic amyotrophy, electrical stimulation, tendon transferAbstract
Aim Parsonage-Turner syndrome (PTS) is a rare but serious condition characterized by spontaneous paresis of the upper extremity, typically lasting for several months with variable recovery. Recent literature reports less optimistic outcome than assumed, with persistent functional impairment in more than half of the patients at 2 years follow-up. Limitation of shoulder abduction is more disabling and the motor recovery needs to be of at least grade 3 to be of functional use. Correction of the residual shoulder deficit is also challenging as the standard tendon transfers for the shoulder abduction provide only modest outcome. However, the modern nerve transfers for the shoulder provide more reliable and better functional outcome. But to be effective they should be performed within 6 to 9 months from the time of onset of the weakness. Knowing that the patients who do not show early recovery are at risk of incomplete recovery in long-term provides a thought that any patient who does not show recovery in 6 to 9 months could be considered for nerve surgery.
Methods We performed nerve surgery in two young male patients with PTS who presented to us at 7 and 8 months with persistent paralysis of shoulder abduction. A combination of neurolysis, tandem stimulation, and nerve transfers was performed based on the intraoperative electrical stimulation findings.
Results Both the patients had satisfactory recovery of shoulder abduction. At 1-year follow-up, they had recovered grade 4 to 5 motor power and had “excellent” outcome based on Narakas grading.
Conclusion PTS patients with shoulder paralysis can be offered nerve surgery if they fail to show recovery in 6 to 9 months since onset of symptoms as late reconstruction with tendon transfers gives only modest outcome. Nerve surgery in the form of neurolysis, electrical stimulation, and nerve transfers provided good outcome in our patients with recovery of shoulder function to normalcy.
