Neuralgic shoulder amyotrophy (brachial neuritis or Parsonage-Turner syndrome) is a rare neurological disease. It was first mentioned in the 1940s. The disease is based on an acute inflammation of the brachial plexus (brachial plexus). A cause for the development of this inflammation could not be found so far.
What is Neuralgic Shoulder Amyotrophy?
Vaccinations, virus infections, operations, injuries or heavy physical exertion usually precede the disease. In most patients, however, no tangible cause can be found. Signs of neuralgic shoulder amyotrophy are severe pain in the shoulder and arm muscles, which can culminate in paralysis. See percomputer for Contagious Impetigo Explanation.
These symptoms are similar to those of a cervical disc herniation. A differential diagnosis can be ruled out by appropriate examinations. Neuralgic amyotrophy of the shoulder mainly affects men and usually occurs between the ages of 20 and 60.
It is rarely hereditary and when it does, it usually begins in the first or second decade of life. The incidence is estimated at 1.64 per 100,000 people annually. The right arm is mostly affected, although it can equally occur on both sides.
Causes
The cause of neuralgic shoulder amyotrophy is unknown. However, a connection with the Coxsackie virus and the cytomegalovirus could be found. Vaccination, physical exertion and heroin addiction are also suspected of promoting the development of the disease.
As a result of the factors mentioned, the sheaths of the brachial plexus become inflamed. This leads to faulty impulse transmission, which in turn causes severe pain and paralysis. The nerve is damaged. Muscle fibers can therefore no longer be controlled properly and become narrower. When the inflammation subsides, the enveloping sheaths form again. Their regeneration is a lengthy process that can take up to a year.
This is caused by the slowly renewing damaged nerve components. Other scientists see circulating immune complexes as the cause of the plexus damage. These are protein compounds found in the blood. Genetic variants are rare but should be considered during investigation.
Symptoms, Ailments & Signs
Neuralgic amyotrophy of the shoulder begins with severe pain in the upper arm and shoulder. This is difficult for many sufferers to bear and lasts for several days to weeks. It is a pain that is equally present during movement as at rest. If it subsides, the affected arm becomes weak. The result is slight paralysis of the shoulder and upper arm muscles. However, these can lead to complete arm plexus paresis (paralysis).
The inflammation makes it difficult or impossible for the patient to lift the inflamed arm. Affected muscles are the deltoid muscle, the supraspinatus muscle, the infraspinatus muscle, the serratus anterior muscle, and the trapezius muscle. The cervical plexus is usually not affected by the inflammation. Inflammation of the diaphragm, musculus biceps brachii, rarely occurs(biceps), individual nerves and nerve branches. Sensory disturbances in the area of the arm and hand can also be observed in a few patients. In most cases, atrophy (wasting of tissue) of the denervated muscles can be seen. A shoulder blade (scapula alata) that protrudes during movement is typical of neuralgic shoulder amyotrophy.
Diagnosis & course of disease
The doctor will first take a medical history and perform neurological tests. Blood tests are atypical for this clinical picture. However, increased antibodies against the Coxsackie virus can be detected in the blood. A positive finding may indicate neuralgic amyotrophy of the shoulder.
Tests of the cerebrospinal fluid are used to determine a possible increase in total protein. If a cerebrospinal fluid test is positive, this can be an expression of cell damage or an increase in inflammatory cells. Since the symptoms of neuralgic amyotrophy of the shoulder are similar to those of irritation of the nerve roots in the neck (caused by a herniated disc or wear), there is occasionally a misdiagnosis.
In this case, an electromyographic examination can lead to a clear finding. With this method, muscle activity is measured using concentric needle electrodes. If there are still doubts, a magnetic resonance imaging (MRI) to detect cervical disc herniation and wear and tear of the cervical spine is useful.
Complications
In about 25 percent of all cases, the neuralgic shoulder amyotrophy does not heal completely. Then the shoulder joint remains permanently paralyzed. The healing process depends on the development of the disease in the first two months. But even if the healing process is ideal, it usually takes two years before you are free of symptoms.
In neuralgic shoulder amyotrophy, the capsule shrinks in the shoulder joint. As a result, complications can occur, which initially manifest themselves as signs of paralysis. If the rotor cuff is paralyzed, there is always a risk of dislocation or subluxation. A dislocation is complete dislocation of the shoulder joint, while a subluxation is incomplete dislocation.
To reduce the risk of dislocation, a bandage should be placed around the shoulder joint. Capsular shrinkage can be reduced with passive shoulder movement. However, even then there is no guarantee that healing will take place without complications. So far, there is no proper treatment concept for this disease, so the patient needs a lot of patience. Cortisone is often used in addition to painkillers.
However, this therapy is controversial because long-term cortisone treatment usually leads to severe side effects. The full picture of Cushing’s syndrome can develop. In addition to obesity with a full moon face and water retention in the body, there are also psychological changes. But even without drug treatment, psychological problems can occur because the healing process takes so long.
When should you go to the doctor?
Pain in the shoulder or upper arm is the first characteristic feature of neuralgic amyotrophy of the shoulder. If they are not caused by a current overload of the body, they must be monitored further. If the pain increases in intensity or persists for several days, you need to see a doctor. Painkillers should only be taken after consulting a doctor. Otherwise, further discrepancies may arise.
If you experience sleep disorders, inner restlessness or if your general resilience decreases, you need a doctor. If you can no longer fulfill your daily obligations or if you can no longer take part in your usual sporting activities, it is advisable to consult a doctor. In the case of signs of paralysis, limitations in the musculoskeletal system and a poor posture of the upper body, the person concerned needs medical support. Discomfort with twisting or raising the arm is uncommon and needs to be seen by a doctor.
It is necessary to clarify the cause so that there are no further impairments or permanent damage to the organism. Sensitivity disorders, numbness on the skin or hypersensitivity to pressure and touching the affected areas on the body must be examined by a doctor. If the general quality of life decreases, if the symptoms lead to behavioral problems or mood swings, the affected person should seek medical care.
Treatment & Therapy
Treatment usually begins with the use of so-called opioids. These are centrally acting drugs that reduce pain. After receiving the diagnosis, the abduction position promotes the recovery process. In this position, the arm is lifted away from the body. In this way, an occurring stiffening of the shoulder joint capsule (more precisely the rotator cuff) can be counteracted.
Otherwise, this leads to luxation (dislocation) or subluxation (dislocation) of the shoulder joint. A bandage becomes essential. Most patients (75%) recover completely within two years of disease onset. Patience is essential. Physiotherapy is required to maintain mobility and strength in the arm and shoulder joint.
It achieves good results in patients with neuralgic shoulder amyotrophy. Since the inflammation of the affected muscles has to be brought to a standstill, cortisone is often used. The use of this drug in this and numerous other conditions is controversial. If taken regularly, cortisone can cause psychological changes.
Stomach bleeding, muscle wasting and other symptoms and illnesses can also occur. Rest and exposure to red light, on the other hand, have no side effects. These measures are recommended by doctors and physiotherapists.
Outlook & Forecast
The prognosis is good for neuralgic shoulder amyotrophy. However, the course is extremely lengthy and the paralysis only recedes gradually within a few years. About half of those affected complain about pain in the arm area over a longer period of time. In 80 to 90 percent of those affected, the disease heals almost completely within two years. Although minor residual symptoms may persist, the bodily functions are usually normal overall and do not impair the quality of life.
The probability of a complete regression of the symptoms of paralysis depends decisively on the healing process in the first few months of treatment. If there is no improvement, future paralysis cannot be ruled out. Physiotherapy exercises and targeted movement exercises under low stress are particularly important for the prognosis. These are particularly important in cases where muscle strength is permanently reduced by the disease. In doing so, certain movement sequences have to be re-learned in part in order to ensure an adequate build-up of strength in the arms. In rare cases (less than 10 percent) relapses – a reappearance of the paralysis – can also occur.
Prevention
No prophylactic measures are currently known.
Aftercare
Despite the limitations that the clinical picture brings with it, those affected should pay close attention to aftercare. Sensible pain management in combination with rehabilitation therapy offer the best conditions for the best possible recovery of the musculoskeletal system. Visits to the physiotherapist help those affected to learn to deal with the symptoms of the disease.
Excessive stress on the shoulder/neck area, such as heavy lifting and prolonged monotonous arm movements, should be avoided. Targeted and controlled exercises, which are learned as part of physiotherapy and also followed at home, are an ideal supplement. If the arm and shoulder are not moved in the long term, there is a risk of paralysis and muscle loss.
This can be counteracted with active and passive physiotherapy. Patients should consciously listen to themselves during aftercare and clarify with the accompanying doctor and physiotherapist what promises relief for the affected area. While some patients prefer cold therapy, others prefer local heat applications and radiation treatments.
A change in diet with low-acid and low-fat foods and avoiding alcohol and drugs is also supportive. Patience is the greatest challenge for those affected by neuralgic shoulder amyotrophy, which can last up to two years in the worst case. The more coordinated the daily but not excessive exercise to restore movement, the more successful the follow-up will be.
You can do that yourself
Sufferers of neuralgic shoulder amyotrophy should pay close attention to their body’s signals. Stressful situations or overexertion should be avoided. If an inflammatory disease is present, it must always be cured. The sufferer harms himself if he puts his body under too much stress before making a full recovery.
A stable immune system is required so that inflammations in the organism can heal better. This can be supported by a healthy lifestyle and a balanced diet. The consumption of harmful substances such as nicotine and alcohol should be avoided. Food should be rich in vitamins. The daily calorie requirement is to be determined according to the existing weight. Existing excess weight should be reduced if possible, as this puts additional strain on the muscles, bones and tendons. The disease is accompanied by severe pain in the shoulders or arms. However, you should not take painkillers on your own responsibility. Rather, relaxation techniques helpor mental training to support the mind. In this way, the perception of pain can be influenced.
In addition, poor posture or one-sided strain on the body should be avoided. These trigger new complaints and lead to an overall deterioration in well-being. If the shoulder becomes permanently paralyzed, the person concerned should seek emotional support. Otherwise, the risk of psychological complications increases.
