Shoulder Reanimation with Nerve-Related Procedures in Chronic Parsonage-Turner Syndrome: A Pilot Study

Abstract

Background : Parsonage–Turner syndrome (PTS), also known as brachial neuritis or neuralgic amyotrophy, is an uncommon disorder affecting peripheral nerves of upper extremity, more predominantly those innervating the shoulder. In the majority of patients, paralysis improves with conservative treatment within a few weeks to a few months. Patients with persistent paralysis improve with nerve-related procedures.

Methods : We report our experience with nerve-related procedures in chronic PTS. A total of 21 cases of PTS with wasting of the shoulder muscles and restricted movements were evaluated at a tertiary care center between March 2014 and May 2022. According to the involvement of peripheral nerve, patients were divided in three groups; Group A consisted of 15 patients with involvement of both the suprascapular nerve (SSN) andaxillary nerve (AXN), Group B had four patients with SSN involvement, and Group C included two patients with isolated AXN involvement. Four patients in Group A also experienced weakness of elbow flexion. Thirteen cases resolved over a period of 3 to7 months, with minor residual deficits. Five cases with paralysis lasting more than7 months were treated with nerve decompression, with or without external neurolysis , epineurolysis, and nerve transfer procedures.

Results : A total of 21 male patients with an average age of 35 years were assessed .Sixteen patients recovered almost completely over a period of 3 to 7 months. Five patients with persistent paralysis underwent neurosurgical procedures. At the 36-month postoperative review, three patients in Group A had regained active shoulder abduction (range: 140–180 °, average 153°) and external rotation (30–60°, average43°). A single patient in Group B regained 160°of active shoulder abduction and 50° of external rotation. Nerve transfer failed in the single patient in Group C with isolated involvement of AXN.

Conclusion : Nerve-related procedures are viable options in patients with PTS who fail to recover with conservative management. We recommend an observation period of7 months before considering surgical intervention.