Chiropractic management of a 30-year-old patient with Parsonage-Turner syndrome

Abstract

Objectives

The purpose of this case report is to describe the chiropractic management of a patient presenting with right arm paralysis and a diagnosis of Parsonage-Turner syndrome.

Clinical Features

After receiving nerve entrapment release surgery, a 30-year-old man presented with a right arm contracture, atrophy, and weakness with general paralysis of the forearm and index finger of 6 weeks' duration.

Intervention and Outcome

The patient was provided chiropractic care that included high-velocity/low-amplitude spinal manipulation based upon applied kinesiology manual muscle testing, soft tissue trigger point therapy, exercises, and stretches. The patient demonstrated improvement in range of motion after the first treatment session. By the eighth treatment, he was able to fully straighten his arm. Three years later, the patient reported that he was able to do mountain climbing and that his arm was fully functional and pain-free.

Conclusion

For this patient, chiropractic care seemed to be successful in relieving his right arm paralysis and restoring normal arm movement.

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.