Disclosures: Martin Pico, MD: No financial relationships or conflicts of interest

Case Diagnosis: Parsonage Turner Syndrome

Case Description or Program Description: A 34-year-old male presented with 1 month of sudden-onset left neck pain radiating to the shoulder. Symptoms began upon waking from sleep without preceding triggers or infection. Pain was severe and rated 8/10. Nonsteroidal anti-inflammatories and muscle relaxants provided moderate relief, but he developed weakness weeks later manifested as difficulty with carrying his child, donning a coat, and overhead activities. Exam demonstrated decreased infraspinatus bulk and weakness with external rotation and abduction. Nerve conduction studies were normal but electromyography (EMG) demonstrated moderate supraspinatus membrane instability and severe infraspinatus instability without residual motor units or reinnervation signs. MRI of the shoulder confirmed intrinsic constriction of the suprascapular nerve consistent with Parsonage-Turner Syndrome (PTS). Subsequent autoimmune, hepatitis, Covid-19, and HIV studies were unremarkable.

Setting: Outpatient Clinic

Assessment/Results: The patient underwent several courses of physical therapy with slow progress but interval improvement in childcare and dressing capabilities.

Discussion (relevance): PTS is a rare disorder that can present with a complex constellation of symptoms. PTS may mirror other pathologies including cervical spondylosis, rotator cuff tendinitis, adhesive capsulitis, or nerve compression by mass lesion. The typical pattern involves abrupt pain followed by weakness after pain has diminished. PTS is often attributed to prior viral infection, immunization, recent surgery, or heavy exercise but can also be idiopathic without identifiable triggers. EMG in conjunction with MRI can be crucial in grading severity of denervation and differentiating PTS from true compression which often requires more invasive interventions. While the majority of patients recover functionally by 3 years with conservative treatments, progress may be slow and physicians should consider long term follow-up with repeat electrodiagnostics to track recovery.

Conclusions: In patients with abrupt shoulder or neck pain followed by progressive neurologic deficits, PTS needs to be considered. Electrodiagnostic studies can both aid in diagnosis and be used to track recovery over time.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/pain-in-the-neck-a-case-report-of-suprascapular-neuropathy-due-to-parsonage-turner-syndrome/