Parsonage turner syndrome: a common syndrome usually missed

Authors

  • Vijay Kumar Pandey Department of Plastic Surgery, Command Hospital, Chandimandir, Haryana
  • Anil Malik Department of Plastic Surgery, Command Hospital, Chandimandir, Haryana http://orcid.org/0000-0003-1515-2122
  • Dev Jyoti Sharma Department of Plastic Surgery, Command Hospital, Chandimandir, Haryana
  • Kumar Pushkar Command Hospital, Wanowrie, Pune, Maharashtra

DOI:

https://doi.org/10.18203/2349-2902.isj20205445

Keywords:

Parsonage-turner syndrome, Serratus anterior muscle, Scapula, Lateral thoracic nerve

Abstract

Background: Parsonage-turner syndrome (PTS) is a rare syndrome that can occur in normal healthy individuals with sudden, rather abrupt, unilateral shoulder pain that may begin rather insidiously but quickly amplifies in severity and intensity. The acute period of pain is subsequently replaced over a course of a few days to weeks with progressive weakness, reflex changes, and sensory abnormalities in varying presentations that typically involve the shoulder girdle musculature and proximal upper limb muscles. There are no definite etiological factors present in causation of this syndrome.

Methods: Prospective multicentric cohort study covering period from 2010 to 2020. 10 young male patients were included in the study group, all of them presented with winging of scapula and pain. Initial evaluation was done at neurology department and after failure of conservative treatment of average period of six month they were referred to plastic surgery department. All patients had ENMG findings preoperatively.

Results: 10 male patients were studied with average age of 24.8 years. Partial paralysis present for an average of 1 year. Repeated micro trauma was the most common aetiology. Intraoperatively 7 patients had anomalous vascular compression of long thoracic nerve (LTN) and three had compression due to fibrous sheath. All patients had complete recovery at end of one year.

Conclusion: Isolated LTN paralysis is a rare condition that is not well known. If conservative management fails, then neurolysis of the distal segment of LTN gives good result if performed within 6-12 months of paralysis.

References

Hamada J, Igarashi E, Akita K, Mochizuki T. A cadaveric study of the serratus anterior muscle and the long thoracic nerve. J Shoulder Elbow Surg. 2008;17:790-4.

Cuadros CL, Driscoll CL, Rothkopf DM. The anatomy of the lower serratus anterior muscle: a fresh cadaver study. Plast Reconstr Surg. 1995;95:93-7.

Pikkarainen V, Kettunen J, Vastamaki M. The natural course of serratus palsy at 2 to 31 years. Clin Orthop Relat Res. 2013;471:1555-63.

Nath RK, Lyons AB, Bietz G. Microneurolysis and decompression of long thoracic nerve injury are effective in reversing scapular winging: long-term results in 50 cases. BMC Musculoskelet Disord. 2007;8:25.

Friedenberg SM, Zimprich T, Harper CM. The natural history of long thoracic and spinal accessory neuropathies. Muscle Nerve. 2002;25:535-9.

Gozna ER, Harris WR. Traumatic winging of the scapula. J Bone Joint Surg. 1979;61A:1230-3.

Disa JJ, Wang B, Dellon AL. Correction of scapular winging by supraclavicular neurolysis of the long thoracic nerve. J Reconstr Microsurg. 2001;17:79-84.

Nath RK, Melcher SE. Rapid recovery of serratus anterior muscle function after micro neurolysis of long thoracic nerve injury. J Brachial Plex Peripher Nerve Inj. 2007;2:4.

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Published

2020-12-28

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Section

Original Research Articles