What is the difference between Parsonage-Turner syndrome and brachial plexus (Brachial Plexus) neuritis?

From the Guidelines

Parsonage-Turner syndrome and brachial plexus neuritis are essentially the same condition, with Parsonage-Turner syndrome being another name for brachial plexus neuritis (also called neuralgic amyotrophy) 1. This condition is a rare inflammatory disorder affecting the brachial plexus, characterized by sudden onset of severe shoulder and upper arm pain followed by weakness and muscle wasting.

Key Characteristics

• Sudden onset of severe shoulder and upper arm pain
• Weakness and muscle wasting
• Inflammatory disorder affecting the brachial plexus

Treatment

Treatment typically involves pain management with NSAIDs like ibuprofen or naproxen for mild cases, and stronger analgesics such as tramadol or gabapentin for more severe pain 1.

• NSAIDs: ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily)
• Stronger analgesics: tramadol (50-100mg every 4-6 hours) or gabapentin (starting at 300mg daily and titrating up to 1800-3600mg daily in divided doses) Corticosteroids like prednisone may be used in the acute phase to reduce inflammation 1.
• Corticosteroids: prednisone (starting at 60mg daily with a gradual taper over 2-4 weeks) Physical therapy should be initiated once the acute pain subsides, typically 2-4 weeks after onset, to maintain range of motion and prevent contractures 1.

Prognosis

Recovery can take months to years, with about 80-90% of patients experiencing significant improvement, though some residual weakness may persist 1. The condition is thought to result from an immune-mediated inflammatory response, often triggered by a preceding infection, vaccination, surgery, or trauma, though the exact pathophysiology remains unclear 1.

From the Research

Parsonage-Turner Syndrome vs Brachial Plexus Neuritis

• Parsonage-Turner syndrome and brachial plexus neuritis are often used interchangeably to describe a condition characterized by sudden onset of severe shoulder and arm pain, followed by weakness and muscle atrophy 2, 3, 4, 5, 6.
• The exact pathogenesis of the condition is unclear, but it is thought to be an immune-mediated neuritis of the brachial plexus, with an underlying predisposition, susceptibility to dysfunction of some peripheral nervous system structure, and a trigger for the attacks, such as viral infection, vaccination, trauma, surgery, and strenuous exercise 3, 5.
• The condition can be idiopathic or hereditary, with the hereditary form being less common and associated with mutations in the SEPT9 gene 2, 5.
• Clinical manifestations of the condition can vary, but common features include:
  • Sudden onset of severe shoulder and arm pain
  • Weakness and muscle atrophy
  • Patchy paresis with amyotrophy
  • Sensory loss in a brachial plexus distribution
  • Involvement of other peripheral nervous system structures, such as the phrenic nerve 2, 3, 4, 5, 6.
• Diagnosis of the condition can be challenging and requires a thorough history and physical examination, as well as nerve conduction velocity and imaging studies 4, 6.
• Treatment of the condition is largely symptomatic and consists of pain management, physical therapy, and rehabilitation to restore functional scapular mechanics and prevent contracture 2, 3, 6.
• High-dose pulsed steroids may be effective in controlling initial pain, but their effect on weakness and subsequent pain is unclear 2, 3.
• Intravenous immunoglobulin and methylprednisolone pulse therapy may also be effective in treating motor impairment in some patients 3.
• Prognosis of the condition is generally good, with most patients experiencing significant recovery over time, although some may be left with residual disabilities 2, 3, 5, 6.