I'd been treating a patient s/p lateral epicondyle ORIF for awhile and noted both a subjective report of loss of biceps strength and visible atrophy of biceps. Initially, I didn't think it was too significant as the patient was not allowed to lift anything with his arm for a couple months. However, as the patient progressed through the later stages of rehab, the atrophy of the biceps remained, even as some strength returned. He had an MRI that revealed no biceps tendon injury, so he was referred to a neurologist. Further testing revealed the patient had the diagnosis of Parsonage-Turner Syndrome.
Parsonage-Turner Syndrome is also known as acute idiopathic brachial neuritis, among other names. The cause is unknown, but is attributed to either viral origin or some form of autoimmune disorder. The neurologist told my patient it can occur after surgery as well. It afflicts 1.64 per 100,000 individuals. Typically the patient presents with pain in the upper quarter, followed up by the onset of muscle weakness and atrophy. What makes it stand out is that the atrophy and weakness remain as the pain subsides. Most of the background information I found associated Parsonage-Turner Syndrome with muscles of the RTC and proximal, however, it can vary as in the case of my patient. For proper diagnosis, be sure to have your patient referred to a neurologist for EMG and NCV. Once diagnosed, there are typically two stages for management. During the acute stage, the patient is instructed to rest and take the appropriate pain medication. Once the pain disappears, the patient should begin physical therapy in order to maintain joint mobility/flexibility and strength in the muscles. Typically, it takes several years to return to prior level of function (longer for elderly patients), and full strength may never return.
As with any case that involves nerve origin, I recommend treating the whole chain as in the case of double crush syndrome. Be sure to address any joint/neural mobility restrictions found. While it is not 100% certain my patient has Parsonage-Turner Syndrome, I thought this would be an interesting pathology to discuss as I was previously unfamiliar with it. For more information, check out this study. Have any of you encountered this pathology before?
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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