Parsonage Turner Syndrome

Overview

What is Parsonage Turner syndrome (brachial neuritis)?

Parsonage Turner syndrome (brachial neuritis) is a neurological disorder that causes sudden and severe pain in your upper arm and shoulder. Weakness in the muscles of the shoulder, arm, forearm or hand follow the pain, which lasts from days to a few weeks.

There’s a network of nerves that go from your spine through your neck, into each of your armpits and then down your arms. This network is called the brachial plexus. Damage to those nerves causes muscle weakness.

Parsonage Turner syndrome is frequently misdiagnosed as cervical radiculopathy or cervical spondylosis.

Parsonage Turner syndrome is also known as:

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

What is the brachial plexus?

The brachial plexus is a complex network of nerves. It starts at the spinal cord and extends like a braid down the side of the neck behind the collar bone to the arm. Nerves of the brachial plexus control movement in the shoulder, arm, forearm, elbow, wrist and hand, and they carry sensation (feeling) from the arm to the spinal cord. The nerves are formed in three trunks (upper trunk, middle trunk and lower trunk) in the neck.

How does Parsonage Turner syndrome (brachial neuritis) develop?

In most cases, the pain strikes all of a sudden, often in the middle of the night, in the shoulder or arm. It’s sharp and intense. The severe pain can last from hours up to four weeks. The muscles of the arm on that side will start to get weak within 24 hours of when the pain started, or a few weeks after.

Weakness is often in the shoulder or upper arm, although it may occasionally be in the forearm or hand. Occasionally, shoulder blade or chest wall muscles, or the diaphragm can be affected. Rarely, involvement of leg, cranial (head) muscles is also reported. When the muscles are weak, muscle tissue can be lost over time. This is called atrophy. Many people also lose some feeling in the arm.

What are the types of Parsonage Turner syndrome?

There are two periods of Parsonage Turner syndrome. The first is the acute phase. This is where the pain is most severe. The pain is less in the second period, known as the chronic phase. In a minority of patients, Parsonage Turner syndrome is caused my genetic factors (hereditary neuralgic amyotrophy).

How common is Parsonage Turner syndrome?

Up to three people per 100,000 get Parsonage Turner syndrome each year.

Who does Parsonage Turner syndrome (brachial neuritis) affect?

More males than females get Parsonage Turner syndrome. Young to middle-aged adults are more likely go get it, but young children and the elderly have reportedly had it, too.

Is Parsonage Turner syndrome an autoimmune disease?

Although traditionally not considered an autoimmune disease, immunological or inflammatory processes are commonly believed to contribute to the occurrence of Parsonage Turner syndrome.

Symptoms and Causes

What causes Parsonage Turner syndrome?

Experts do not know the exact cause of Parsonage Turner syndrome. However, there are several theories, including:

  • A virus or infection. About 25% of people report that they had a virus or infection right before they got Parsonage Turner syndrome. It is unclear if the virus or infection actually triggered the syndrome. There are rare reports of Parsonage Turner syndrome after a COVID-19 infection.
  • Vaccinations. About 15% of cases occurred after a vaccination.
  • Trauma. A motorcycle crash or a football injury, for example, can cause trauma to the shoulder.
  • Cancerous cells.
  • Immunizations or a faulty immune system.
  • Lumbar puncture (spinal tap).
  • Recent surgery, childbirth, or radiation treatment.
  • Parasitic infection.
  • Rheumatologic disorders and autoimmune disorders.
  • Heroin use.

Parsonage Turner syndrome may be hereditary.

What are the symptoms of Parsonage Turner syndrome?

Because people are different, the severity of pain, location of pain and/or duration of pain and weakness won’t be the same. Symptoms of Parsonage Turner syndrome may include:

  • Sudden sharp, aching, burning or stabbing pain (gradual in rare cases).
  • Pain in one shoulder (rarely in both shoulders). Possible pain also in the neck, arm and hand (on the same side as the painful shoulder). Pain in the legs (rare).
  • Pain is worse during the evening or during the night. Pain may be mild or unbearable and incapacitating.
  • Muscle weakness in the shoulder (days or weeks after the initial pain). The weakness can be mild, severe, or almost paralyzing (this is rare).
  • Problems with reflexes.
  • Loss of sensation or numbness. Feeling tickling, prickling, or burning.
  • Partial dislocation of the shoulder joint. Abnormal range of movement of joints. Winged scapula (a condition where the shoulder blade sticks out).
  • Shortening of the muscles or tendons.
  • Shortness of breath (rare). Excessive sweating.
  • Red, purple, or spotted hands. Swelling.

Is Parsonage Turner syndrome contagious?

No. Damage to the nerves is not contagious.

Diagnosis and Tests

How is Parsonage Turner syndrome diagnosed?

Your healthcare provider will note your symptoms. He or she will test for muscle strength, reflexes and feeling in your arm. If your healthcare provider thinks you have Parsonage Turner syndrome, he or she may want you to have a test called an electromyography (EMG). This test consists of two parts:

  • In the first part, nerves are shocked in a controlled fashion and responses are measured.
  • In the second part, tiny needles are inserted in various muscles of the arm to study the electrical activity of those muscles at rest and with movement. The EMG can help determine the location, nature and severity of nerve damage.

The EMG test takes one to two hours. It may hurt a little bit as the needles are put in. You may get sore and your arm may tingle for a few hours after the test.

You might also have an MRI scan, nerve ultrasound and/or CT scans to confirm the diagnosis, or rule out other conditions.

What questions might my healthcare provider ask to diagnose Parsonage Turner syndrome?

  • When did your pain start?
  • How long did it last?
  • Where did you feel the pain?
  • How do your joints feel?
  • Are you experiencing weakness?

Management and Treatment

How is Parsonage Turner syndrome (brachial neuritis) treated? What medicines may help?

Experts have yet to find a specific treatment for Parsonage Turner syndrome. Some treatments that may work for you include:

  • Using painkillers to manage the pain. The pain is worse when the problem first starts. Medications such as tricyclic antidepressants, duloxetine or gabapentin may also be used for pain. Steroid medications such as prednisone may be considered in the early phase. The pain lessens as the months pass.
  • Your doctor may suggest you do physical and occupational therapy for three to eight weeks. This can help with your range of motion and help keep your strength up.
  • TENS (transcutaneous electrical nerve stimulation) may help with the pain by changing or blocking nerve transmissions.

What are the surgical treatments?

Surgery is considered only after other treatments fail. You might have a nerve grafting or tendon transfer. A nerve graft is where the surgeon takes a bit of nerve tissue from another part of your body and uses it to repair damaged nerves. Similarly, a tendon transfer is where a healthy tendon is removed from another part of your body to replace a damaged tendon in, for example, your shoulder.

What can I do to help relieve symptoms of Parsonage Turner syndrome?

Try cold packs or heating pads to help with the pain. Be sure to take any and all medications recommended by your healthcare provider.

Is there a cure for Parsonage Turner syndrome?

Treatment can help you manage the symptoms and eventually, after months or years, you should return to your normal self. However, about 10% to 20% of people will continue to have some ongoing pain and poor endurance.

What healthcare providers will treat/manage my Parsonage Turner syndrome (brachial neuritis)?

General practitioners, orthopedists and/or neuromuscular disease specialists may be involved in your treatment.

Prevention

Can Parsonage Turner syndrome be prevented?

There is no known way to prevent Parsonage Turner syndrome. However, it is best to remain as healthy as possible by eating a nutritional diet and exercising (under your healthcare provider’s supervision).

What foods can I eat or avoid to reduce my risk of Parsonage Turner syndrome (brachial neuritis)?

At this time there are no foods known that affect Parsonage Turner syndrome.

Outlook / Prognosis

What is recovery from Parsonage Turner syndrome like?

Getting over Parsonage Turner syndrome is slow, often over months. The pain is worse at the start and gets better over time. Most people (70% to 90%) make a good recovery of strength and arm use over two to three years. Occupational therapy may help you be able to work while you are getting better.

With a Parsonage Turner syndrome injury that comes from sports (trauma), the weakness and stinging normally lasts only minutes or hours. If it lasts longer, the injury may be more serious.

Is Parsonage Turner syndrome fatal?

No. However, there’s a possibility that you might become disabled.

How long will I have Parsonage Turner syndrome?

This is difficult to predict. It varies from person to person. It may be weeks, or it may be years. The average is three to four months.

Can Parsonage Turner syndrome go away on its own?

Yes. Some people see the pain disappear and get their strength back without treatment.

Can Parsonage Turner syndrome happen more than once?

Yes. Some people get Parsonage Turner syndrome several times. 75% of people with Parsonage Turner syndrome will have one episode while 25% will have more.

Living With

Can I live a normal life with Parsonage Turner syndrome (brachial neuritis)?

Parsonage Turner syndrome may limit some of your activities. Be sure to take painkillers during the acute phase. Work hard at your physical therapy so that you can recover quickly. Get help from family and friends if you need it. Follow your healthcare provider’s instructions!

How can my family and friends help?

Parsonage Turner syndrome can cause severe weakness – sometimes it’s even debilitating. You may need help with everyday tasks that involve moving or lifting. For example: getting dressed, opening cupboards, or driving. Update your friends and family about your symptoms and limitations so that they can help you!

When should I see my healthcare provider?

Early and correct diagnosis of Parsonage Turner syndrome is vital. See your healthcare provider when you have pain, especially if it’s sudden and severe.

What questions should I ask my healthcare provider about Parsonage Turner syndrome (brachial neuritis)?

  • What caused my Parsonage Turner syndrome?
  • What painkillers do you recommend?
  • How soon do you think I will recover?
  • What treatment do you recommend?

A note from Cleveland Clinic

Parsonage Turner syndrome (brachial neuritis) is characterized by sudden, intense pain followed by severe weakness. Both the pain and the weakness can severely interfere with your quality of life. Contact your healthcare provider when you get the pain in your shoulder and arm so that you can start treatment as soon as possible.

Last reviewed by a Cleveland Clinic medical professional on 11/27/2020.

References

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  • Gonzalez-Alegre P, Recober A, Kelkar P. Idiopathic Brachial Neuritis. Iowa Orthop J. 2002;22:81-95. Accessed 11/4/2020.
  • Barreto Monteiro dos Santos R, Monteiro dos Santos S, Carneiro Leal FJC, et al. Parsonage-Turner syndrome. Rev Bras Ortop. 2015 May-Jun;50(3):336-341.
  • NORD: National Organization for Rare Disorders. Parsonage Turner Syndrome. (https://rarediseases.org/rare-diseases/parsonage-turner-syndrome/) Accessed 11/4/2020.

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