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| ==Background==
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| *Syndrome characterized by sudden onset, severe shoulder pain followed by weakness and sensory loss as pain resolves over the course of days to weeks
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| *Also known by many other names including acute brachial neuritis, acute brachial plexitis, idiopathic brachial plexopathy, neuralgic amyotrophy
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| *More common in males in the 4th decade of life
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| *Can affect any part of the brachial plexus
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| **Most commonly affected nerves: long thoracic nerve, suprascapular nerve, axillary nerve, musculocutaneous nerve, radial nerve
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| *Up to 1/3 may have bilateral involvement<sup>2</sup>
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| *Upper trunk most frequently affected<sup>3</sup>
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| *May have preceding viral syndrome
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| *Two forms
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| **Idiopathic
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| **Hereditary
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| ==Clinical Features==
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| *Severe shoulder girdle pain
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| *Weakness, paresthesias, and sensory losses that depend on which nerves are involved
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| *Muscle atrophy may develop after several weeks of neuropathy
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| *Loss of reflexes
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| *Scapular winging
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| ==Differential Diagnosis==
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| *[[Brachial plexopathy]]
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| **Idiopathic
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| **Post-infectious
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| ***Viral
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| ****[[Epstein-Barr]], [[CMV]], [[influenza]], [[parvovirus]], [[coxsackie]], [[HIV]], [[Polio]]
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| ***Bacterial
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| ****[[Lyme]], [[Leptospirosis]], [[TB]], [[Salmonella]]
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| **Post-immunization
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| **Compressive
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| ***Neoplasm
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| ****[[Pancoast tumor]]
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| **Post-traumatic
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| ***Penetrating or blunt neck/shoulder trauma
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| ***Traction injury
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| ***Birth trauma
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| ****[[Erb's palsy]]
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| ****[[Klumpke's paralysis]]
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| **Connective tissue disorders
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| **Autoimmune disorders
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| ***[[Lupus]]
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| ***[[Polyarteritis nodosa]]
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| ***[[Temporal arteritis]]
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| **Iatrogenic
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| ***Post-surgical
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| ***Medication induced
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| ***Radiation
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| **Hereditary Neuralgic Amyotrophy
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| *[[Rotator Cuff Injury]]
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| *[[Adhesive capsulitis]]
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| *[[Calcific tendinitis]]
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| *[[Thoracic outlet syndrome]]
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| *[[ALS]]
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| *[[Poliomyelitis]]
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| ===Upper extremity [[peripheral nerve syndromes]]===
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| ====Median Nerve Syndromes====
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| *[[Median Mononeuropathy (Carpal Tunnel Syndrome)|Carpal tunnel syndrome]]
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| *[[Pronator teres syndrome]]
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| *[[Anterior interosseous neuropathy]]
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| ====Ulnar Nerve Syndromes====
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| *[[Ulnar neuropathy at the elbow and wrist]]
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| ====Radial Nerve Syndromes====
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| *[[Radial neuropathy at the spiral groove]] (ie. "Saturday night palsy")
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| *[[Posterior interosseous neuropathy]]
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| ====Proximal Neuropathies====
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| *[[Suprascapular neuropathy]]
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| *[[Long thoracic neuropathy]]
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| *[[Axillary neuropathy]]
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| *[[Spinal accessory neuropathy]]
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| *[[Musculocutaneous neuropathy]]
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| ====Other====
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| *[[Brachial plexopathy]]
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| *[[Cervical radiculopathy]]
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| ==Evaluation==
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| *Plain films if there is history of trauma
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| *Consider [[MRI]] in the ED to rule out acute cervical spine pathology
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| *Outpatient brachial plexus [[MRI]]/MRN
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| *Outpatient EMG - should be performed at least 3 weeks after symptom onset to show findings<sup>4</sup>
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| ==Management==
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| *Early conservative management
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| **NSAIDs, sling, physical therapy
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| **Antiviral medications if etiology is viral in nature
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| **Oral steroids recommended by some in early disease for pain<sup>3,4</sup>
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| *Operative management considered for space occupying lesions or if no recovery is seen in 6-9 months
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| **Nerve decompression, neurolysis, neurorrhaphy, nerve transplant/grafting, muscle/tendon transplant/grafting
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| ==Disposition==
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| *Depends on etiology - acute traumatic injuries may need urgent or emergent surgery
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| *Most idiopathic cases can be discharged with neurology/orthopedics follow up
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| *Full recovery can take up to 2-3 years
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| ==See Also==
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| ==External Links==
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| ==References==
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| <references/>
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| # Feinberg et al. Parsonage-Turner Syndrome. HSSJ. 2010;6:199-205.
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| # Misamore et al. Parsonage-Turner Syndrome (Acute Brachial Neuritis). Journal of Bone and Joint Surgery. 1996;78(9)1405-1408.
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| # Moghekar et al. Brachial Plexopathies: Etiology, Frequency, and Electrodiagnostic 4. Localization. Journal of Clinical Neuromuscular Disease. 2007;9(1):243-247.
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| # Ortiz Torres M et al. Brachial Plexitis (Parsonage Turner Syndrome, Brachial Neuropathy, Brachial Radiculitis) [Updated 2020 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK448114/
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