Functional recovery
Do patients recover from Parsonage Turner Syndrome?
It is often thought that most patients will recover fully with time. This is not always the case and in fact the extent and speed of the recovery is often overestimated.
Cup EH et al, 2013 lead a cohort questionnaire study of 248 patients with Parsonage Turner syndrome (either idiopathic or hereditary).1 The patients were seen in the neurology outpatients and as a direct referral to their brachial plexus clinic. All patients in the study had a last episode of PTS more than 6 months from the time of questionnaire.
In this study, the outcomes of the questionnaire was not documented in relation to time from last episode but 33% of patients were from 6 months to 1 year, 30% from 1 year to 2 years and 37% greater than 2 years.
Results
Pain
· 38% patients reported no pain with 62% experiencing pain at rest.
· 60% patients had pain in the affected shoulder on movement or when lying on it.
· Pain was reported as continuous (‘nagging’) in nature in 56%.
· Most (82%) found the pain to be more severe in the evening.
· Mean pain score (visual analog score) was 47 (range 33 to 64).
· 59% experienced paraesthesia in the arm during stretching or lifting of the arm.
Restriction of activity
· The pain caused restriction on activities of daily living in 54% patients.
· At times when patients did not experience pain, 60% were still restricted by residual loss of strength or endurance in the affected limbs.
· 33% patients could not lift their arm above their head.
· Winging of the scapula was present in 44% patients at rest and 55% during lifting or reaching with the arm.
Fatigability of the arm & shoulder
· 80% had increased fatigability of the arm and shoulder during repeated movements or postures.
· Correlation analysis confirmed the intimate relation between pain and scapular instability, problems with overhead activities, and increased muscle fatigability that can lead to strain.
Conclusions
· Persisting pain and disabilities are a common sequel for a proportion of patients with Parsonage Turner Syndrome.
· Treatment that improves scapular stability and periscapular muscle endurance and decreases or spreads out periscapular load over the day is most likely to reduce persisting pain.
References
1. Cup EH, Ijspeert J, Janssen RJ, Bussemaker-Beumer C, Jacobs J, Pieterse AJ, van der Linde H, van Alfen N. Residual complaints after neuralgic amyotrophy. Arch Phys Med Rehabil. 2013 Jan;94(1):67-73. https://www.doi.org/10.1016/j.apmr.2012.07.014