Information on the following diseases can be found in the Related Disorders section of this report:

• Peripheral Neuropathy
• Lyme Disease
• Rheumatoid Arthritis

Parsonage-Turner syndrome is a neuromuscular condition. It is characterized by the sudden (acute) onset of severe pain across the shoulder and upper arm due to inflammation of the group of nerves that control the muscles of the chest, shoulders, and arms (brachial plexus). In some cases, the pain may radiate down the arm and into the hand. The degree and intensity of the pain varies among those affected, so that some patients feel no pain but exhibit weakness of the muscles. Local pain around the shoulder girdle is the characteristic symptom. The pain may extend toward the elbow, but seldom beyond the elbow.

Within a few hours or days of the condition’s onset, affected individuals may experience muscle weakness, wasting (atrophy), numbness (hyperesthesia), and paralysis of the muscles of the affected shoulder and, in rare cases, muscles of the hand and fingers. In some cases, the condition may affect both sides of the body (bilateral). People with this condition usually recover within a few months although symptoms may sometimes last for a few years. Recovery is usually complete.

The exact cause of Parsonage-Turner syndrome is not known. This disorder has been associated with bacterial or viral infections, particularly of the upper respiratory tract. Also implicated have been parasitic infections, surgery, vaccinations, childbirth, and various intrusive medical procedures such as lumbar puncture and X-ray opaque dyes. Some clinical-scientists believe that this may be an autoimmune disorder. Autoimmune disorders are caused when the body’s natural defenses against "foreign" or invading organisms (e.g., antibodies) begin to attack healthy tissue for unknown reasons.

Parsonage-Turner syndrome may also arise as a result of another systemic illness, such as polyarteritis nodosa, lymphoma, systemic lupus erythematosis, temporal arthritis, and Ehlers-Danlos syndrome.

Parsonage-Turner syndrome can affect anyone, but is seen most often in young to middle aged adult males.

Symptoms of the following disorders can be similar to those of Parsonage- Turner syndrome. Comparisons may be useful for a differential diagnosis:

Peripheral neuropathy is a syndrome characterized by sensory, motor, reflex and blood vessel (vasomotor) symptoms. These symptoms can occur singly or in any combination. (For more information on this disorder, choose "Peripheral Neuropathy" as your search term in the Rare Disease Database.)

Lyme disease is a tick-transmitted inflammatory disorder characterized by an early focal lesion, and subsequently a growing red area on the skin (erythema chronicum migrans or ECM). The disorder may be followed weeks later by joint pain resembling arthritis and neurological or heart abnormalities. (For more information on this disorder, choose "Lyme" as your search term in the Rare Disease Database.)

Rheumatoid arthritis is a common disease that affects the joints. The exact cause is unknown although it is believed to be an autoimmune disorder. It is characterized by a loss of appetite, extreme fatigue and joint pain with deformities. The location of painful joints may change (migration). Very often more than one joint is affected. Pain, early morning stiffness, aching joints chiefly in the hands, knees, feet, jaw and spine occur. Once affected, a joint may remain painful for a long time and eventually become deformed. (For more information on this disorder, choose "Arthritis" as your search term in the Rare Disease Database.)

Diagnosis
The diagnosis of Parsonage-Turner syndrome is made by exclusion. Many other syndromes mimic PTS. X-rays and MRI studies (magnetic resonance imaging studies) may be used in the process of exclusion.

Treatment
There is no treatment specifically effective for PTS. Many patients will recover without any treatment. Physical therapy or surgery may be helpful for some people with this disorder. Other treatment is symptomatic and supportive.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.

For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

McKusick VA, ed. Online Mendelian Inheritance In Man (OMIM). The Johns Hopkins University. Amyotrophy, Hereditary Neuralgic; HNA. Entry Number; 162100: Last Edit Date; 10/19/2005.

TEXTBOOKS
Sahoo S, Pearl PL. Parsonage-Turner Syndrome. In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:577-78.

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:1490-92.

Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:581-82.

JOURNAL ARTCILES
Elsayes KM, Sharriff A, Staveteig PT, et al. Value of magnetic resonance imaging for muscle denervation syndromes of the shoulder girdle. J Comput Assist Tomogr. 2005;29:326-29.

Ryan M, Twair A, Nelson E, et al. Whole body magnetic resonance imaging in the diagnosis of Parsonage Turner syndrome. Acta Radiol. 2004;45:534-39.

Khandelwal D, Bhatia M, Singh S, et al. Threshold intensity and central motor conduction time in patients with monomelic amyotrophy: a transcranial magnetic stimulation evaluation. Electromyogr Clin Neurophysiol. 2004;44:357-60.

McGillicuddy JE. Cervical radiculopathy, entrapment neuropathy, and thoracic outlet syndrome: how to differentiate? Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004;1:179-87.

Akuhota V, Chou LH, Drake DF, et al. Sports and performing arts medicine. 2. Shoulder and elbow overuse injuries in sports. Arch Phys Med Rehabil. 2004;85(3 Suppl 1):S52-S58.

Coppieters MW, Stappaerts KH, Wouters LL, et al. The immediate effects of cervical lateral glide treatment technique in patients with neurogenic cervicobrachial pain. J Orthop Sports Phys Ther. 2003;33:369-78.

Kufeld M, Claus B, Campi A, et al. Three-dimensional rotational myelography. AJNR Am J Neuroradiol. 2003;24:1290-93.

FROM THE INTERNET
Ashworth NL. Brachial Neuritis. emedicine. Last Updated: May 16, 2005. 11pp.
www.emedicine.com/pmr/topic58.htm

Kolev I. Parsonage-Turner syndrome. Orphanet. Update: July 2004. 7pp.
www.orpha.net/data/patho/GB/uk-Turner.pdf

NERVE: PROXIMAL MOTOR. Neuralgic amyotrophy. Neuromuscular Center. Washington University of St. Louis. nd. 3pp.
www.neuro.wustl.edu/neuromuscular/nanatomy/proxmot.html#heredbp