Parsonage-Turner Syndrome

What is Parsonage-Turner syndrome?

Parsonage-Turner syndrome (brachial neuritis) is a neurological condition that causes sudden and severe pain in your shoulder and upper arm. The pain can last from a few days to a few weeks. Muscle weakness in your shoulder, arm, forearm or hand then follows the pain. The weakness can last for several months.

The syndrome happens due to damage to your brachial plexus. It’s a network of nerves that go from your spine through your neck, into both of your armpits and then down your arms. Parsonage-Turner syndrome (PTS) mainly affects motor nerves and axons. These nerves are responsible for controlling movement. This is why it leads to muscle weakness.

PTS is rare, so healthcare providers often misdiagnose it as cervical radiculopathy (pinched nerve) or cervical spondylosis. These are much more common conditions that have similar symptoms.

The syndrome is named after two British neurologists: Maurice Parsonage and John Turner. They described the condition in 1948. PTS is also known as:

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

Phases of Parsonage-Turner syndrome (brachial neuritis)

There are usually three phases of Parsonage-Turner syndrome:

• Phase 1 (acute pain phase): This involves severe and sudden pain that usually affects one shoulder. This phase — and the pain — can last a few days to weeks. In general, the longer this phase lasts, the longer it takes to recover.
• Phase 2: After the pain subsides, you start to develop muscle weakness, such as arm and shoulder girdle weakness. This can lead to muscle loss (atrophy). Phase 2 typically lasts six to 18 months, but can last longer.
• Phase 3: After some time, your muscles regain strength and functionality.

How common is Parsonage-Turner syndrome?

Parsonage-Turner syndrome (brachial neuritis) is rare. Up to 3 people per 100,000 get PTS each year.

Anyone at any age can get the syndrome. But it more commonly affects people assigned male at birth (AMAB) than people assigned female at birth (AFAB). The average age of onset is 41 years.

What are the symptoms of Parsonage-Turner syndrome?

Sudden pain and subsequent muscle weakness are the main symptoms of Parsonage-Turner syndrome. They can affect your:

• Shoulder.
• Upper arm.
• Forearm.
• Hand.

In about 80% of cases, it only affects one arm (unilateral) — most often your dominant arm/hand. In about 20% of cases, it affects both arms (bilateral). Rarely, it can also affect your lower trunk and lower extremities.

In most cases, the pain strikes all of a sudden. It’s sharp and intense and is often worse at night. Severe pain can last for hours up to four weeks. After the pain goes away, the muscles in your affected arm will start to get weak.

You’ll likely experience muscle weakness in your shoulder or upper arm, although it can also affect your forearm and hand. Occasionally, weakness can affect your chest or diaphragm. When your muscles are weak, you lose muscle tissue over time (muscle atrophy).

The severity of the symptoms can vary widely from one person to another due to the specific nerves PTS affects. Other symptoms of PTS can include:

• Problems with your reflexes in your affected arm.
• Abnormal sensations (paresthesia) or numbness in your affected arm. This may feel like tickling, prickling or burning.
• Partial shoulder dislocation.
• Abnormal range of motion in your affected joints.
• Winged scapula (when your shoulder blade sticks out).
• Shortening of the muscles or tendons in your affected arm.
• Red, purple or spotted hands (due to poor circulation).
• Swelling in your hands.
• Shortness of breath (dyspnea). This is rare.

What causes Parsonage-Turner syndrome?

Researchers don’t know the exact cause of Parsonage-Turner syndrome. They think an abnormal reaction of your immune system (immune-mediated response) is the main contributor. They have two theories:

• Viral, bacterial or parasitic infections directly affect your brachial plexus, causing the symptoms.
• Your immune system attacks the bacteria, virus or antigen and damages your brachial plexus in the process.

Having a recent viral infection is the most common trigger of PTS. The following viral illnesses are most typically involved:

• Coxsackie B virus, which can cause several conditions, like pneumonia, gastrointestinal illness, myocarditis, aseptic meningitis, encephalitis and viral hepatitis.
• HIV (human immunodeficiency virus).
• Fifth disease (parvovirus B19).
• Mumps.
• Smallpox (variola major and minor).

In some cases, healthcare providers can’t determine a triggering event. In rare cases, Parsonage-Turner syndrome happens due to a genetic (inherited) condition called hereditary neuralgic amyotrophy.

What are the risk factors for developing Parsonage-Turner syndrome?

Researchers believe that certain conditions and situations may make you more vulnerable to developing Parsonage-Turner syndrome. These include:

• Recent surgery and/or anesthesia.
• Connective tissue diseases, like Ehlers-Danlos syndrome.
• Autoimmune conditions, like lupus (systemic lupus erythematosus), temporal arteritis and polyarteritis nodosa.
• Traumatic shoulder injury.
• Strenuous exercise involving your shoulder.
• Vaccines (immunizations).
• Pregnancy and childbirth.
• Radiation therapy.
• Lumbar puncture (spinal tap).
• Receiving contrast dye for an imaging test.

How is Parsonage-Turner syndrome diagnosed?

Your healthcare provider will ask about your symptoms and medical history and do a physical exam. They’ll test for muscle strength, reflexes and feeling in your arm. They may refer you to a neurologist.

If your provider thinks you have Parsonage-Turner syndrome, they may recommend a test called an EMG (electromyography). It evaluates the health and function of your skeletal muscles and the nerves that control them.

You might also have the following imaging tests to confirm the diagnosis or rule out other conditions:

• MRI (magnetic resonance imaging) scan.
• Nerve ultrasound.
• CT (computed tomography) scan.

What is the treatment for Parsonage-Turner syndrome?

There’s no specific treatment or cure for PTS — it usually goes away on its own. But early diagnosis and supportive treatments can help improve your outlook (prognosis).

Your healthcare provider will recommend certain therapies for managing your symptoms. You may have a team of specialists that crafts a care plan. This team may include:

• Primary care physicians (PCPs).
• Orthopaedists.
• Neurologists.
• Neuromuscular disease specialists.
• Physical therapists.

Therapies for the acute pain phase may include:

• Analgesics (pain medicine, like over-the-counter NSAIDs).
• Oral corticosteroids.
• Immobilizing your arm by limiting your use of it or using a shoulder stabilizer.
• Transcutaneous electrical nerve stimulation (TENS).
• Acupuncture.

Once the acute phase is over, your provider will likely recommend the following therapies:

• Physical therapy: A physical therapist can teach you stretching and strengthening exercises to help your affected muscles and joints recover.
• Co-analgesics: These are medications that specifically treat nerve pain. Examples include gabapentin, carbamazepine and amitriptyline.

In severe cases, your provider may recommend surgery if nothing else has helped your symptoms. Surgical techniques may include nerve grafting or tendon transfers.

Can I prevent Parsonage-Turner syndrome?

As researchers don’t know the exact cause of PTS, there’s nothing you can do to prevent it. Certain viruses may trigger PTS, so staying as healthy as possible may help lower your chances of getting it.

What is the prognosis for Parsonage-Turner syndrome?

The prognosis (outlook) for PTS can vary. Some people only experience one episode of PTS and fully recover their strength in the affected areas. Other people have persisting weakness and pain. And some people develop PTS more than once (recurrence).

Some factors that may increase your risk of a poorer prognosis include:

• Having a vagina.
• Persistent pain and lack of muscle recovery by three months.
• If PTS affects your lower trunk/abdomen.
• If the cause is hereditary. These cases have much more common recurrence rates.

According to a study, 89% of people with PTS who received symptom management and physical therapy recovered within three years. About 75% of those people recovered within two years and 36% within the first year.

Recent studies show that many people continue to have pain and some functional issues. But a full recovery of strength is possible and can take up to eight years.

When should I see my healthcare provider?

Early and correct diagnosis of Parsonage-Turner syndrome is crucial. See a 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?

• What caused my case of Parsonage-Turner syndrome?
• Which specialists should I see?
• What pain medications do you recommend?
• How should I take care of myself at home?
• How soon do you think I’ll recover?
• What treatment do you recommend?
• How will I know if PTS has gotten better or worse?

A note from Cleveland Clinic

Experiencing sudden, severe pain can be alarming. It’s your body’s signal that something is wrong, so it’s important to see your healthcare provider as soon as possible. Many treatment options can help manage the symptoms of Parsonage-Turner syndrome (PTS) and may speed up your recovery. If you have any questions about PTS, don’t hesitate to ask your provider. They’re available to help.