Pain P-PA001. Parsonage turner syndrome

Abstract

Introduction . Parsonage Turner Syndrome (PTS) is a rare syndrome that may occur in healthy subjects. The clinical presentation might not be typical and risk factors attributed to the development of disease may not be easily depicted. We present a case of abrupt onset of unilateral shoulder pain, followed by progressive neurologic weakness. Result . A 54-year-old male presented with abrupt onset of shoulder pain mainly on the right side. Pain was felt in both shoulder and thigh which progressed to weakness, dysesthesia, and numbness in the right upper arm. In 4 days, he could barely lift his right upper arm. There was no history of trauma nor infection on the affected area. On physical examination, there were limitation of shoulder abduction and external rotation. His right arm strength from proximal to distal was 1344. Other extremities showed no significant weakness. Sensory involvement did not match dermatomal and peripheral sensory distribution. Nerve Conduction Velocity (NCV) showed axonal motor neuropathy of right axillary nerve. Electromyography (EMG) showed no Motor Unit Action Potential (MUAP) on deltoid muscle. His CK was 457, and there was an increase in LDH and CRP. Cervical MRI was unremarkable. Steroids were immediately given, and the response was fast and satisfactory. After 1 day, his motor strength increased, and the pain subsided. EMG showed single MUAP on deltoid. After 10 days, his motor strength returned to near normal. NCV study showed decreased amplitude of right axillary nerve, and recruitment was slightly decreased on right deltoid muscle. He underwent physical therapy and was making marked progress. Conclusion . PTS generally involves one upper limb, and axillary nerve is one the most commonly involved. PTS should be considered as a differential diagnosis in cases of shoulder pain and arm weakness without any clear etiology.