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Review
Neuralgic amyotrophy: a paradigm shift in diagnosis and treatment
  1. Clemens Gstoettner1,
  2. Johannes A Mayer1,2,
  3. Stephanie Rassam1,3,
  4. Laura A Hruby1,4,
  5. Stefan Salminger1,5,
  6. Agnes Sturma1,6,
  7. Martin Aman1,7,
  8. Leila Harhaus7,
  9. Hannes Platzgummer8,
  10. Oskar C Aszmann1,5
  1. 1Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
  2. 2Department for Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen at the Eberhard Karls University Tuebingen, Tuebingen, Germany
  3. 3Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
  4. 4Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
  5. 5Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
  6. 6Department of Bioengineering, Imperial College London, London, UK
  7. 7Department of Hand, Plastic and Reconstructive Surgery, Burn Center-Hand and Plastic Surgery, University of Heidelberg, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
  8. 8Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Professor Oskar C Aszmann, Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna Department of Surgery, 1090 Wien, Austria; oskar.aszmann{at}meduniwien.ac.at

Abstract

Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is characterised by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. Recent reports have shown that incidence is much higher than previously assumed and that the majority of patients never achieve full recovery. Traditionally, the diagnosis was mainly based on clinical observations and treatment options were confined to application of corticosteroids and symptomatic management, without proven positive effects on long-term outcomes. These views, however, have been challenged in the last years. Improved imaging methods in MRI and high-resolution ultrasound have led to the identification of structural peripheral nerve pathologies in NA, most notably hourglass-like constrictions. These pathognomonic findings have paved the way for more accurate diagnosis through high-resolution imaging. Furthermore, surgery has shown to improve clinical outcomes in such cases, indicating the viability of peripheral nerve surgery as a valuable treatment option in NA. In this review, we present an update on the current knowledge on this disease, including pathophysiology and clinical presentation, moving on to diagnostic and treatment paradigms with a focus on recent radiological findings and surgical reports. Finally, we present a surgical treatment algorithm to support clinical decision making, with the aim to encourage translation into day-to-day practice.

  • peripheral nerve surgery
  • clinical neurology
  • neurosurgery
  • neuromuscular
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Footnotes

  • Contributors CG and OCA devised the concept of this review; CG performed the literature review with the help of JAM; CG wrote the manuscript with the help of SR, LAH, SS, AS, HP and OCA; JAM contributed the clinical case; HP contributed the radiological cases; CG and OCA created the treatment algorithm with input from JAM, SR, LAH and SS; MA and LH critically revised a draft of the manuscript and added further input; JAM, SR, LAH, SS, AS, MA, LH, HP and OCA reviewed and revised the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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