Disclosures: Jessica Kao, DO: No financial relationships or conflicts of interest

Case Diagnosis: Neuralgic amyotrophy in a 40-year-old female with severe left arm pain followed by weakness, numbness and tingling

Case Description: Patient presented with complaints of numbness and tingling in her left shoulder and arm for the past 2 months. She had initially been evaluated at the Emergency Department, where she was prescribed steroids, outpatient physical therapy, and nonsteroidal anti-inflammatory drugs. Upon further questioning, she revealed first having severe shoulder pain, later followed by weakness and difficulty holding onto objects. She denied any preceding event including illness, surgery, trauma, or vaccination.

Setting: Academic Outpatient Electrodiagnostic LaboratoryAssessment/

Results: Electrodiagnostic testing showed absent lateral antebrachial cutaneous sensory nerve response and electromyographic findings of neuropathic changes in a multifocal distribution in the left arm. Physical exam revealed winged scapula and left arm weakness. Neuromuscular ultrasound showed fascicular torsion, tenderness to sonopalpation, and enlargement of the median nerve at the mid-humerus.

Discussion: Neuralgic amyotrophy, or Parsonage-Turner Syndrome, is a rare syndrome with an incidence of about 1.64 in 100,000 people, although actual rates may be higher due to difficulty with diagnosis. Men and individuals in their third to seventh decades are more commonly affected. Patients typically present with unilateral shoulder pain that is then replaced by weakness and sensory and reflex changes. Scapular winging can occur when the long thoracic nerve is affected. The most common risk factors include viral illness and immunization, in addition to some association with vasculitides. Diagnosis is clinical but can be aided by electrodiagnostic testing to quantify denervation and reinnervation of muscles. Treatment involves therapy and pain management with medications, acupuncture, or transcutaneous electrical nerve stimulation, and some studies also recommend steroids and immunotherapy.

Conclusion: Neuralgic amyotrophy is a rare but potentially disabling condition that is often misdiagnosed. Early recognition is important for proper pain management and therapy, which significantly improves patients’ function and quality of life.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/neuralgic-amyotrophy-in-a-patient-with-arm-weakness-and-paresthesias-a-case-report/