[Shoulder_Case_#04] [Moderate level] Parsonage turner syndrome, shoulder pain

Innervation

 

Supraspinatus muscle : suprascapular nerve (C5,6)

Infraspinatus muscle : suprascapular nerve (C5-6)

Teres minor muscle : axillary nerve (C5-6)

Subscapularis muscle : upper and lower subscapular nerves (C5-6)

Deltoid muscle : axillary nerve (C5-6)

 

Triceps brachii muscle: radial nerve, branches of ulnar nerve

Teres major muscle : lower subscapular nerve (C5, C6)

Teres minor muscle : axillary nerve (C5-6)

Coracobrachialis muscle : musculocutaneous nerve (C6 and C7)

The hallmark presentation of Parsonage-Turner syndrome, occurring in the vast majority of patients is an abrupt onset of severe, relentless pain in the neck, shoulder, and/or arm, frequently causing awakening from sleep, lasting for 4 weeks on average, followed by the rapid onset of multifocal weakness and atrophy, usually in the upper extremity, with variable sensory deficits that are not usually pronounced

 

This is predominantly seen in the distribution of the suprascapular and to a lesser degree axillary or long thoracic nerves or their combinations. 

The muscle changes are predominantly noted in the supraspinatus and infraspinatus muscles, and much less frequently in the deltoid and teres minor, followed by subscapularis, latissimus dorsi, pectoralis, and rhomboids

 

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In Parsonage-Turner syndrome, edema in affected muscles is typically diffuse, either homogeneous or heterogeneous. 

Heterogeneous involvement may include “watery” edema, particularly about the musculotendinous junctions.

 

Parsonage-Turner syndrome should also be high on the differential in any patient with diffuse edema in muscles supplied by different nerves given its propensity for multifocal involvement.

 

Perifascial fluid and/or subcutaneous edema adjacent to affected musculature is not a feature of PTS and should suggest another diagnosis.

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