What is Parsonage Turner Syndrome (PTS)?

Parsonage Turner Syndrome (PTS) is a condition affecting the brachial plexus, a network of nerves located in the shoulder area, beneath the clavicle. These nerves control movement and sensation in the arm and hand. PTS leads to pain and weakness in the arm and hand. The syndrome was first described by Dr. Parsonage and Dr. Turner in the 1940s.

 

What happens to the brachial plexus in PTS?

In PTS, the brachial plexus becomes irritated or inflamed, causing damage to the outer coating of the nerves (myelin), and in some cases, the inner part of the nerves (axons).

 

What are the symptoms of PTS?

The first symptom is usually shoulder pain, which may come on suddenly or develop gradually. The pain is often described as aching or stabbing, with sharp, burning, or tingling sensations. It may spread to the neck, arm, or hand, and tends to worsen later in the day. In some cases, the pain can be debilitating, lasting from days to months. Muscle weakness in the affected arm may follow, with the specific pattern of pain and weakness depending on which nerves are involved.

 

What are the signs of PTS?

Examination may reveal loss of sensation, muscle weakness, and diminished reflexes. Prolonged weakness can result in muscle wasting, contractures, or shoulder subluxation. Involvement of the autonomic nervous system may cause changes in skin color, swelling, abnormal hair or nail growth, and altered temperature sensitivity. The skin may become less sensitive or overly sensitive, making it painful to touch. Occasionally, nerves outside of the brachial plexus may also be affected.

 

What is the prognosis of PTS?

Most patients recover well, though full recovery can take 1-2 years. However, some may experience long-term pain or persistent muscle weakness. A few patients may have recurrent episodes of PTS.

 

What causes PTS?

The exact cause of PTS is unknown, but it is believed to involve an immune system malfunction that damages the nerves. PTS can be triggered by several factors, including intense physical activity, minor trauma, surgery, immunizations, infections, childbirth, or autoimmune disorders. In many cases, a recent viral infection is the most common trigger, although no clear cause is identified in some instances.

 

How common is PTS?

PTS is rare, affecting 2-3 people per 100,000. It is more common in men, and there may be a genetic predisposition.

 

How is PTS diagnosed?

Diagnosis is based on the patient’s symptoms and physical examination, supported by nerve conduction studies and electromyography (EMG). MRI can be helpful, especially in the early stages, to confirm the diagnosis.

 

How is PTS treated?

There is no specific treatment for PTS as the exact cause is unknown. Management focuses on relieving pain, restoring muscle strength, and addressing complications. The use of steroids is debated, and treatments like intravenous immunoglobulin (IVIG) are being explored.

 

Where can I find more information about PTS?
For more information, you can visit the American Academy of Neurology.