Parsonage-Turner Syndrome
What is Parsonage-Turner Syndrome?
Parsonage-Turner syndrome (PTS) is an uncommon neurological disorder characterized by sudden severe pain in the shoulder and arm. This acute phase may last for a few hours to a few weeks and is followed by wasting and weakness of the muscles (amyotrophy) in the affected areas. PTS involves mainly the brachial plexus — the network of nerves extending from the spine through the neck, into each armpit and down the arms — which controls movements and sensations in the shoulders, arms, elbows, hands, and wrists. The condition is usually self-limited, though recovery can be prolonged.
PTS was first described in 1948 by English physicians Maurice Parsonage and Aldren Turner. In their seminal paper, they reported on 136 World War II soldiers who had developed brachial plexus inflammation, the majority of whom had a history of recent infection, surgical procedures, or trauma.
Synonyms
- Neuralgic amyotrophy
- Brachial plexus neuritis
- Idiopathic brachial plexopathy
Parsonage-Turner syndrome (PTS) is an uncommon neurological disorder characterized by sudden severe pain in the shoulder and arm. This acute phase may last for a few hours to a few weeks and is followed by wasting and weakness of the muscles (amyotrophy) in the affected areas. PTS involves mainly the brachial plexus — the network of nerves extending from the spine through the neck, into each armpit and down the arms — which controls movements and sensations in the shoulders, arms, elbows, hands, and wrists. The condition is usually self-limited, though recovery can be prolonged.
PTS was first described in 1948 by English physicians Maurice Parsonage and Aldren Turner. In their seminal paper, they reported on 136 World War II soldiers who had developed brachial plexus inflammation, the majority of whom had a history of recent infection, surgical procedures, or trauma.
- Estimated incidence: 1–3 per 100,000 persons annually (likely underdiagnosed)
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More common in males (≈2:1 ratio)
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Peak onset: 20–60 years, but can occur at any age
| Name | Abbreviation |
|---|---|
| Neuralgic amyotrophy | NA |
| Brachial plexus neuritis | |
| Idiopathic brachial plexopathy |
The exact cause of PTS is not fully understood, but it is believed to be an immune-mediated inflammatory response. In many cases, an event "triggers" the immune system to attack the nerves. Common triggers include:
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Viral or bacterial infections
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Recent surgery
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Vaccinations
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Strenuous physical activity or trauma
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Childbirth
There is also a rare genetic form known as Hereditary Neuralgic Amyotrophy (HNA), caused by mutations in the SEPT9 gene, which encodes a protein involved in cell division called septin 9.
There are usually three phases of PTS:
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Phase 1 (acute pain phase): Severe and sudden pain that usually affects one shoulder. In most cases the pain is sudden, sharp and intense, often worse at night, and can last from hours to up to several weeks.
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Phase 2 (weakness phase): After the pain subsides, perhaps days to weeks later, muscles in the affected arm begin to weaken — typically in the shoulder or upper arm, though the forearm and hand can also be affected. Numbness, tingling or a “pins and needles” sensation may occur.
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Phase 3 (recovery phase): Gradual return of strength and function over months to years.
In about 80% of cases, only one arm is affected (unilateral), most often the dominant arm. In about 20% of cases, both arms are affected (bilateral). Rarely, symptoms can also affect the lower trunk and lower extremities. PTS can also involve the phrenic nerve, controlling the diaphragm, causing labored breathing.
PTS is typically a diagnosis of exclusion, as there is no blood test or biomarker that can categorically confirm it. Symptoms can mimic other conditions, and as a result, it is often misdiagnosed. Tools used for diagnosis include:
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Clinical Evaluation: A thorough physical exam and medical history.
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Electromyography (EMG) & Nerve Conduction Studies (NCS): To assess nerve damage and muscle response.
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MRI: Often performed on the shoulder or cervical spine to rule out other causes; specialized "MR Neurography" can sometimes show inflammation of the brachial plexus nerves.
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Ultrasound: To look for nerve enlargement or constriction.
There is no cure for PTS, so treatment focuses on managing symptoms and supporting recovery:
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Pain Management: During the acute phase, doctors may prescribe NSAIDs, corticosteroids (to reduce inflammation), short-term opioids in severe cases, or nerve-pain medications (like gabapentin).
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Physical Therapy: This is vital to maintain the range of motion in the joints and strengthen the muscles as the nerves recover.
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Occupational Therapy: To help with activities of daily living if hand or arm function is limited.
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Surgery: In rare, chronic cases where nerves do not recover on their own, nerve grafts or tendon transfers may be considered.
The prognosis for PTS is generally favorable, but recovery is often very slow. Most patients (about 70–90%) recover a significant amount of function within 1 to 3 years. Some individuals may experience residual weakness, exercise-induced pain, or permanent muscle atrophy. Recurrence is possible, particularly in the hereditary form of the disease.
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Feinberg, J. H., & Radecki, J. (2010). “Parsonage-turner syndrome.” HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 6(2), 199–205. https://doi.org/10.1007/s11420-010-9176-x.
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Al Khalili Y, Jain S, Lam JC, et al. (2024). “Brachial Neuritis.” In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499842/
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National Organization for Rare Disorders (NORD): Parsonage-Turner syndrome.
Last updated 5 Feb 2015, 10:13 AM
5 Feb 2015, 10:11 AM
Would like to talk to people with this syndrome, what kind of treatment program or therapy you had that helped. Been seeing pain management doctor. No physical therapy. Take different meds, use heat & ice. Tens unit does not help. Would like some recommendations on what else to try.
Last updated 12 Aug 2012, 11:08 PM
11 Aug 2012, 05:23 AM
Yeah i have been in this since late 04 and mine progressed to paralysis although some function and motor skills have returned i am still considered a high function Quadriplegic as i have loss of nerve function in all extremities, i also suffered through lots of pain until Doctors finally put me on opiates, now i'm doing much better, there is no "over" this its getting through this with your sanity intact it is a genetic mutation that will be passed to any off spring and with each generation the mutation will become more severely affected offspring. Or i should say that is if you have HNA,because i have HNA and Muscular Dystrophy i have been told that there is a 1 in 9 billion chance of another person having these two diseases, and with me they appeared together at the same time and it took a lot of Neurologists telling me i had ALS before i found one who was able to see that not all of the symptoms could be attributed to one disease and started figuring things out and doing genetic tests until he got his answers.
10 Aug 2012, 02:35 PM
I woke up one night 3 years ago with severe pain in my right arm. Thinking I has just slept wrong I went to the couch to watch TV and wait for some Tylenol to kick in. Within an hour the pain was so bad I had to wake up my husband and rush to the ER. While there the pain shot across to my left arm. The doctors had no idea what was wrong with me, but sent me home anyhow. It took 2 weeks for me to get in to see a neurologist. My neurologist is my hero, within 10 minutes of talking to me, he knew what was wrong. He explained the disease and sent me off to the hospital for 5 days of outpatient IV steroid treatments, he also put me on gabapentin, gave me some other pain meds and sent me to physical therapy. PT helped and they sent me home with a tens unit (small unit that delivers electro shocks) So now here I am 3 years later, still in pain and still with weak arms. I take Neurotin which helps a little and I still use my tens unit all the time. In the beginning I was hopeful, after reading that 75% make a full recovery. Now I am starting to believe that I am going to be one of the 25%. I guess there are options to administer medication through injection that will block the nerves and there is surgery. Both of these options sound so very dangerous to me. Anybody here been in this longer than me?
Last updated 9 Jul 2012, 02:12 AM
9 Jul 2012, 02:12 AM
I know you are posturing your arm for comfort and relief i did the same thing for awhile and then when it was paralyzed it was always in my way banging into things so i carried it in a splint,problem is now i have a permanently bent elbow, for love nor money can i get this thing to go all the way straight so you must resist that urge to fist it across your chest otherwise you will pay for it later in loss of mobility.
14 Jun 2012, 11:59 PM
So I have this pain in my right four arm.. I cant extend my arm straight. If & when I do I have a shooting pain like an electric shock run down my arm.. My hand by my thumb and pointer finger go numb and tingles.. If the pain starts i have to put pressure on my fore arm by the elbow crease or just under it! My arm feels better in an up position fisted to my chest! Please let me know what types of pains you are having?
Last updated 6 Jul 2012, 10:13 PM
6 Jul 2012, 10:13 PM
I was a Paramedic/Firefighter until 10 years ago when at the same time i developed Muscular Dystrophy And PTS and Doctor after Doctor Diagnosed me as having Lou Gehrig's Disease (ALS) and telling me i would be dead within three years, Until i ran across a Neurologist who said i don't think we are looking at one disease not everything fits right,I think we have two diseases appearing at the same bad time and he sure was right!! and i have have gone through periods of paralysis the longest being my right arm and hand which lasted 5 years and currently it's playing ping pong in my legs but i lost my ability to walk 6 years ago and with my arms being the way they are i have had a power wheelchair for along time so it can play its little games anyway nice to see people here.
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