Case reportChiropractic management of a 30-year-old patient with Parsonage-Turner syndrome
Introduction
Parsonage-Turner syndrome (PTS) is an entity that is also known as acute brachial neuritis, neuralgic amyotrophy, brachial neuropathy, or neuritis of the shoulder girdle. This plethora of descriptive terminology does not lead to a readily available diagnosis, with it being easily confused with other upper extremity abnormalities, including anomalies of the rotator cuff, acute calcific tendinitis, adhesive capsulitis, cervical spondylosis, peripheral nerve compression, tumor, acute poliomyelitis, and amyotrophic lateral sclerosis.1
Internationally, PTS has been described in many countries, although the specific incidence has been reported. The incidence in the United States has been estimated at approximately 1.64 in 100 000 per year with an unknown etiology.2 It appears to affect males more than females, with a peak in incidence in patients in their third and seventh decades.3, 4
This condition was first documented by Spillane5 in 1943 and by Parsonage and Turner6 in 1948. Parsonage and Turner described 136 cases of this condition and stated these features as strongly diagnostic of PTS:
- •
discrepancy for muscles wasting and denervation between muscles innervated by the same nerve.
- •
patchwork distribution of denervation of muscles that are innervated by several nerves or nerve trunk arising from the brachial plexus.
- •
dissociation between sparing of the sensory nerve action potential and denervation of muscles depending on the same mixed nerves.
Treatments have traditionally been based upon symptomatic relief. Suggested biomedical treatment protocols for PTS include analgesics, often narcotics (which may be required for several weeks); physical therapy for 3 to 8 weeks to help maintain strength and mobility; and encouragement that the condition will slowly improve. The profound weakness in the shoulder muscles may require the use of a sling. Corticosteroids, although frequently used, are of unproven benefit. Along with these treatments, suggested rehabilitation programs include physical therapy focused on the maintenance of full range of motion in the shoulder and other affected joints, occupational therapy in the form of functional conditioning of the upper extremity, and surgical intervention including nerve grafting or tendon transfers for the few patients who do not achieve good recovery by 2 years. Surgery usually is aimed at improving shoulder abduction.7 The objective of this article is to describe one patient's response to chiropractic care for a patient with PTS or acute brachial neuritis.
Section snippets
Case report
A 30-year-old right-handed-dominant athletically built man presented to a chiropractic office with paralysis of the right arm with a diagnosis of PTS. Excluding this condition, he was in excellent health. He neither smoked nor drank alcohol. He worked in a sporting goods store and was an avid mountain climber. There were no related cases of family members having had similar symptoms.
The patient had been healthy until 6 weeks earlier when he awoke with a slight discomfort in his right arm. He
Discussion
The possible mechanisms for the results obtained in this case are varied. Because it appears that the patient responded favorably to conservative manual therapy such as CMT and deep tissue treatment, this tentatively corroborates with the proposed mechanism of hypomobility of the fifth cervical vertebra and peripheral entrapment between the anterior and middle scalene muscles and the first rib. It is also consistent with an entrapment between a hypertonic pectoralis minor muscle, coracoid
Conclusion
This case demonstrated that a patient with PTS who did not respond to standard medical or pharmaceutical intervention derived benefit from conservative care, namely, chiropractic management using applied kinesiological modalities.
Funding sources and potential conflicts of interest
No funding sources or conflicts of interest were reported for this study.
References (18)
Localised neuritis of the shoulder girdle
Lancet
(1943)- et al.
Neuralgic amyotrophy. The shoulder-girdle syndrome
Lancet
(1948) - et al.
Parsonage-Turner syndrome (acute brachial neuritis)
J Bone Jt Surg
(1996) - et al.
Brachial plexus neuropathy in the population of Rochester, Minnesota
Ann Neurol
(1985) - et al.
Paralytic brachial neuritis
JAMA
(1960) - et al.
Brachial neuritis
Clin Orthop
(1999) - et al.
Acute brachial plexus neuritis: an uncommon cause of shoulder pain
Am Fam Phys
(2000) - Cocchiarella L, Andersson GB. Guides to the evaluation of permanent impairment. 5th ed. Chicago: American Medical...
Cited by (4)
Chiropractic Management of a Patient With Radial Nerve Entrapment Symptoms: A Case Study
2019, Journal of Chiropractic MedicineCitation Excerpt :Therapeutic options include conservative care (eg, rest, modified activities, splinting at the wrist and elbow, anti-inflammatory drug therapy, and corticosteroid injections) and surgery.6 Chiropractic management with complementary use of applied kinesiology (AK) manual muscle testing (MMT) seemed useful in neuropathic conditions, such as meralgia paresthetica and Parsonage-Turner syndrome.7,8 In addition to standard orthopedic and neurologic assessments, chiropractors with an AK approach use MMT to identify what are believed to be immediate neurologic responses to a variety of challenges and treatments.9
Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: A systematic review
2013, Journal of Manipulative and Physiological TherapeuticsCitation Excerpt :This review is essentially limited to recommendations for short-term treatment described as ≤ 3 to 6 months. There are a growing number of RCTs assessing outcomes at 3 months—approximately 30% of the overall studies listed but—still very few RCTs, or any type of study, have assessed MMT for these or many other upper extremity disorders (for example for treatment of a post Colle’s fracture and similar) for up to or longer than 6 months.23,24,37,83,92,104,119-122,124-126,130,133,139,140,142,189,217,224,235,239-243 There are a few RCTs (in some of the categories) that have extended a follow-up to ≥ 1 year (or a few ≥ 6 months) such as Bisset et al and Smidt et al for lateral epicondylopathy.24,83
Applied kinesiology: Distinctions in its definition and interpretation
2012, Journal of Bodywork and Movement TherapiesCitation Excerpt :A marked increase of the patient's reading ability to his own grade level was noted as well (Cuthbert and Rosner, 2010a). A 30-year-old male with a right arm contracture, atrophy, and weakness resulting in a general paralysis of the forearm and index finger responded favorably in 8 treatment sessions to conservative care guided by AK diagnostic methods, whereas previous surgical and pharmacological interventions had failed (Charles, 2011). A consecutive sample of 157 children aged 6–13-years with documented histories of difficulties in reading, learning, social interaction, and school performance received a multimodal chiropractic treatment protocol, including applied kinesiology techniques.
Chiropractic management of a geriatric patient with idiopathic neuralgic amyotrophy: A case report
2017, Journal of the Canadian Chiropractic Association