Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 3
Disclosures: Jason S. Hua: Nothing to disclose
Case Description: 62-year-old patient with a history of polycythemia presents to PMR clinic with a chief complaint of right shoulder pain that started 2 years ago, he reports feeling it "pop" while he was lifting a piano for a friend. He states that there was initially some pain but he was able to tolerate it. He states that around 1 year ago he started having more pain with associated weakness. Exam revealed right arm weakness out of proportion to mechanism injury. 2/5 deltoid, 5/5 biceps 4/5 triceps, 1/5 shoulder abduction. Significant atrophy in the supraspinatus, infraspinatus and deltoids. He denied antecedent viral illness, fasciculations, dysarthria and dysphagia. MRI revealed severe atrophy of the rotator cuff and deltoid muscles in more than one nerve distribution. Concerning for denervation syndrome such as Parsonage-Turner syndrome. Moderate rotator cuff tendinosis. Focal high-grade tearing of the anterior supraspinatus.
Setting: Outpatient PMR MSK clinic.
Patient: 62-year-old Hispanic male
Assessment/Results: Electrodiagnostic evidence of sensory, motor, axonal, demyelinating peripheral polyneuropathy in arms and legs tested. EMG with increased insertional activity in right biceps, infraspinatus with faciculations/sharp waves. Biceps, triceps, rhomboids, FDIM, TA with decreased recruitment. Large MUAP in Infraspintus, Rhomboids, FDIM.
Discussion: This is an interesting case of Parsonage-Turner diagnosis presented 2 years after initial onset of injury. When he was initially evaluated, shoulder pathology was initially thought to be attributed to shoulder osteoarthritis and rotator cuff tear. He did not present to a PMR or sports medicine clinic until 2 years following the initial injury for evaluation.
Conclusion: It is important to keep routine surveillance in patient with shoulder injuries as there may be underlying conditions such as Parsonage-Turner syndrome. Early detection can lead to earlier treatment and more aggressive therapies and or surgical interventions to preserve function.
Level of Evidence: Level V
To cite this abstract in AMA style:Hua JS, Thomas J. Parsonage-Turner Syndrome in the Setting of Rotator Cuff Tear Following Heavy Lifting Injury [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/parsonage-turner-syndrome-in-the-setting-of-rotator-cuff-tear-following-heavy-lifting-injury/. Accessed December 3, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/parsonage-turner-syndrome-in-the-setting-of-rotator-cuff-tear-following-heavy-lifting-injury/