Differential diagnosis
What is the Differential Diagnosis for Parsonage Turner Syndrome?
Parsonage Turner syndrome often has a typical presentation that once is seen is rarely forgotten. Other causes of shoulder pain associated with muscular weakness, muscular atrophy and sensory symptoms can be considered by examinining other causes of plexopathy, other neurological conditions and musculoskeletal conditions affecting the shoulder.
Other causes of Plexopathy
Traumatic
Direct brachial nerve injury, symptoms correlate with mechanism of injury
Thoracic Outlet Syndrome
Weakness of the thenar and hypothenar eminences. Slowly progressive and painless. Associated with paraesthesia
Pancoast Tumour
Slow onset apical lung tumour. Affects the lower cord of the brachial plexus. Associated with Horner’s syndrome.
Post-radiation
Delayed (2-20 year) following radiotherapy for neck, axilla or chest wall carcinomas. Causes severe neurological pain with progressive sensory motor deficits in the upper limb.
Post-Thoracotomy
Direct brachial nerve injury, usually lower trunk.
Other Neurological Conditions
Spondylitic Cervical radiculopathy
Gradual onset with pain and paraesthesia from neck down upper extremity. May lead to weakness. Positive Spurling’s test.
Discogenic cervical radiculopathy
Acute onset with dermatomal distribution. Varies with posture. Positive Spurling’s test.
Mononeuritis Multiplex
Painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas.
Entrapment Neuropathies
Symptoms in isolated single nerve distribution. Less severe pain and sensory symptoms predominate.
Musculoskeletal conditions
Rotator cuff problems
Tenderness of the Greater Tuberosity. Increased pain on movement, particular raising the arm above the shoulder.
Adhesive capsulitis
Gradual onset (years). Pain causing a reduced range of motion.
Bicipital tendon pathology
Insidious and gradual onset of pain, worsened by movement.
Acromioclavicular joint pathology
Often caused by injury or degeneration. Localised pain with swelling and reduced range of motion.
Complex Regional Pain Syndrome
Vasomotor symptoms following disuse or immobilisation. Often affecting the distal limb.