Parsonage-Turner syndrome, also called acute brachial neuritis, is a rare neurological disorder characterized by sudden and severe shoulder pain followed by weakness or numbness in the upper extremities, typically affecting just one arm. Onset is often rapid, with symptoms worsening over about 2 weeks but gradually growing less painful over a period of months. It is estimated that just 5 in 100,000 people develop Parsonage-Turner syndrome each year. Without treatment, full recovery may take up to 3 years, though some residual pain or weakness often remains. Getting early evaluation from a doctor experienced in upper extremity issues is key, as quick diagnosis allows for appropriate therapy to maximize strength and function. If the nerves do not regain function on their own, surgery may be required. Delaying treatment risks permanent nerve damage and long-term disability.
Parsonage-Turner Syndrome
Treatments
There is no definitive cure for Parsonage-Turner syndrome, so treatment focuses on managing symptoms and improving function while allowing time for potential nerve recovery. The main goal of treatment is to retain as much strength and mobility in the affected arm and shoulder as possible. Initial treatment typically involves rest, pain medication, gentle range of motion exercises to prevent frozen shoulder, and physical therapy to encourage nerve regeneration and rebuild lost muscle through specific exercises. Should nerve and muscle recovery plateau and significant dysfunction remain, surgery may be considered. Though recovery varies widely, starting physical therapy early maximizes the chances of a good outcome.
Non-Surgical Treatments
Rest
Resting the affected arm and avoiding strenuous activity is important during the acute phase to allow the inflamed nerves time to heal. Use of a sling may be recommended.
Medications
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce inflammation and pain. Nerve modulators may be prescribed for severe nerve pain as well.
Physical Therapy
Once the acute pain phase passes, physical therapy is started to prevent frozen shoulder, maintain range of motion, regain strength through specific exercises, and encourage nerve regeneration. Electrical nerve stimulation may also be used.
Stretching/Exercises
Gentle range of motion stretches, and exercises are important to prevent scar tissue formation that could restrict movement. As strength returns, resistance exercises build muscles impacted by nerve damage.
Braces
Braces, splints, or other supportive devices may be used to stabilize and protect the arm during early healing and nerve recovery.
Surgical Treatments
Decompressive Surgery
If imaging shows evidence of compressed nerves causing symptoms, surgery can be done to open up passages and provide more space for those nerves to allow them to recover. Recent data suggests that Parsonage-Turner may cause microconstrictions of the nerves, which can be alleviated with microsurgery.
Nerve grafts
A procedure that takes a healthy nerve from another area of the body or a donor and transplants it to reconnect and restore function to the damaged nerve.
Nerve transfers
A procedure that takes a less important healthy nerve that performs a similar function and transfers it to restore function to the damaged nerve. For example, transferring a nerve that controls a less needed muscle to the nerve for a more crucial muscle.
Muscle Transfers
In certain cases where particular muscles are severely impacted, less-affected muscles may be detached and transferred to restore some function. This is seen as a reconstruction option after failed nerve recovery.
Tendon transfer surgery
A procedure that takes a working tendon that performs a similar function as a paralyzed tendon and transfers it to restore movement and function lost due to nerve damage.
Contact Us Today
Why Patients Trust the Center for Hand & Upper Extremity Surgery
Our experienced surgeons at the Center for Hand and Upper Extremity Surgery use a comprehensive treatment approach to help patients with complex conditions like Parsonage-Turner syndrome. Our fellowship-trained hand specialists on staff offer the highest level of expertise while our integrated care teams closely coordinate rehabilitation needs to accelerate your recovery. Our goal is not just resolving pain or achieving baseline function, but maximizing abilities to allow engagement in all the activities patients could perform before injury or illness. With higher patient satisfaction scores than other regional centers, the expertise and personalized care at the Center for Hand and Upper Extremity Surgery delivers life-changing results.
When to Seek Medical Attention
Parsonage-Turner syndrome requires prompt medical attention to maximize recovery chances and functioning. If you experience sudden, severe shoulder and upper arm pain, seek emergency care to rule out issues like stroke or heart attack first. Once Parsonage-Turner is suspected due to arm and shoulder pain combined with arm muscle weakness, numbness, or tingling, you should make an appointment with your primary care doctor right away for evaluation and diagnosis. Getting a neurological consult early on can also facilitate swift access to physical or occupational therapy guidance.
Don’t assume the nerve and muscle issues will self-resolve. Statistics show the earlier therapy is initiated in Parsonage-Turner syndrome cases, the better the long-term outcomes typically are in regaining strength and range of motion. Persistent or worsening pain and neurological symptoms also warrant follow-up for assessment of whether surgical interventions like nerve decompression or nerve grafts will be necessary for recovery. Don’t hesitate to get medical help or specialist referrals if arm weakness continues impacting daily activities several months post-onset.
Frequently Asked Questions
The exact cause is unknown, but it is thought to be an autoimmune reaction or reaction to a virus/infection that results in inflammation and damage to the brachial plexus nerves.
Yes, potential risk factors include recent viral illness, immunizations, surgery, physical trauma, or strenuous activity involving the shoulders and arms (though cause/effect is not proven). Underlying diabetes or immune disorders may also increase susceptibility.
In addition to discussing symptoms and performing a physical exam of arm/shoulder flexibility and strength, doctors can use nerve conduction studies and electromyography tests to evaluate nerve function. MRI scans may also reveal nerve inflammation or compression.
With prompt treatment, full recovery is common if nerve damage is mild. If nerves are severely compressed for too long before treatment, some permanent weakness or functional impairment may remain. However, therapy often restores good hand and wrist use.
Most patients see steady improvement after 12-18 months, but full recovery may take longer s. About 80% of patients recover close to normal limb function with early therapy. However, some residual pain, weakness, or numbness often remains for life, especially if nerve damage is severe.
Recurrence is not common, but a small percentage may experience issues again months or years later, usually on the opposite side. Preventative measures are uncertain since the cause itself remains unknown. Some have episodes of symptoms that come and go.
