Disclosures: Vishal Bansal, MD: No financial relationships or conflicts of interest

Case Diagnosis: 62-year-old female with Parsonage-Turner Syndrome with recent history of non-traumatic spinal cord injury status-post C3-T2 posterior spinal instrumentation and fusion (PSIF).

Case Description or Program Description: Her inpatient rehabilitation stay was notable for post-operative profound neck pain and bilateral shoulder pain with radicular symptoms followed by flaccid weakness. Musculoskeletal specialists were consulted and subsequent trigger point injections to the trapezius, right sub-acromial bursa and right acromio-clavicular joint steroid injection were completed without any appreciable relief. During her stay the left upper limb improved with pain and strength however the right upper limb lagged in recovery and 4 months post-discharge right upper limb weakness persisted. MRI arthrogram of the right shoulder was indicated and revealed edema of the supraspinatus, infraspinatus, teres minor, and deltoid muscles with a partial thickness tear of the supraspinatus. EMG was performed and notable for no recruitment in the right deltoid, infraspinatus, and biceps.

Setting: Acute Inpatient Rehabilitation Hospital

Assessment/Results: The patient was diagnosed with Parsonage Turner Syndrome based on MRI findings that were further supported by electromyography (EMG) findings. EMG results showed proximal muscle (i.e., deltoid, biceps) denervation, indicative of brachial plexus involvement. It is presumed that the preceding cause of the Parsonage-Turner Syndrome was due to auto-immune reaction following PSIF or iatogrenic.

Discussion (relevance): Literature describes Parsonage-Turner Syndrome as a condition with shoulder pain with a radicular component and weakness that follows and confirmed with EMG and/or MRI. Approximately 75% of patients make a complete recovery within 2 years and a portion of affected patients can experience a relapse in symptoms but to a lesser degree and duration. This is a self-limiting condition with a focus on supportive management.

Conclusions: This case highlights an uncommon clinical presentation of Parsonage-Turner Syndrome. Clinicians should be cognizant of this differential when evaluating a patient with atypical recovery cervical PSIF after a cervical spinal cord insult to limit patient morbidity and costly diagnostic work-up.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/parsonage-turner-syndrome-after-cervical-thoracic-fusion-a-case-report/