Seema Parikh, MD
Resident Physician
New-York Presbyterian Columbia/Cornell
Bridgewater, New Jersey, United States
Richard Tran, MD
Resident Physician
New-York Presbyterian Columbia/Cornell
New York, New York, United States
Jessica Ye, MD
Resident Physician
New-York Presbyterian Columbia/Cornell
New York, New York, United States
Ahish Chitneni, DO
Resident Physician
New-York Presbyterian Columbia/Cornell
New York, New York, United States
A 36-year-old woman presented with right upper extremity pain, numbness, and weakness that started several days after an uncomplicated, spontaneous vaginal delivery. Pain and numbness radiated to her right scapula and triceps and lasted two weeks before spontaneous resolution. However, she experienced continuing progressive weakness, loss of range of motion, and worsening scapular winging. She tried physical therapy without improvement. Physical exam was notable for right shoulder active range of motion limited to 90 degrees in flexion and 15 degrees in external rotation, 3/5 strength in abduction and external rotation, and right scapular lateral winging with wall push-ups. MRI brachial plexus was largely unremarkable. EMG showed findings consistent with right-sided upper trunk brachial plexopathy, acute/subacute denervation changes of right-sided C5-C6 myotomes, and sparing of cervical paraspinal, rhomboid major, and serratus anterior muscles. Clinical presentation and findings are most consistent with Parsonage-Turner Syndrome.
Discussions:
Parsonage-Turner Syndrome is a rare neurologic condition that presents with rapid onset unilateral shoulder pain that is subsequently replaced over the course of a 1-2 weeks with progressive weakness and sensory abnormalities. The etiology of this brachial plexopathy is unclear, however, symptoms are often associated with a preceding event, including trauma, surgery, infection, vaccinations, or in this case, pregnancy. Management is aimed at preserving function through physical and occupational therapy, although these treatments do not necessarily expedite recovery. Glucocorticoids have been suggested, although no clinical trials have shown their efficacy; as this patient was breastfeeding, steroids were deferred.
Conclusions: Given the rare and idiopathic nature of Parsonage-Turner Syndrome, careful history and high suspicion are critical for diagnosis. EMG may also prove valuable. This case adds to the literature the number of Parsonage-Turner Syndromes associated with the peripartal period, for which prior studies demonstrated an 8.7% associated incidence.
