Neuralgic shoulder amyotrophy
| Classification according to ICD-10 | |
|---|---|
| G54.5 | Neuralgic amyotrophy |
| ICD-10 online (WHO version 2019) | |
The neuralgic shoulder amyotrophy (actually: shoulder mya trophie, from the English usage the name Parsonage-Turner syndrome is common) is a neurological disease of unknown cause. It is a non-hereditary form of neuralgic amyotrophy .
The disease is commonly interpreted as inflammation of the arm nerve plexus ( plexus brachialis ) by immune complexes . Mostly the right arm is affected, and both sides can become ill.
There is an association with the hepatitis E .
Symptoms
The first symptom is a severe, tearing pain in the shoulder and upper arm area that lasts for a few days. This quickly leads to severe paralysis of the shoulder and upper arm muscles. The deltoid muscle is particularly affected , along with the supraspinatus , infraspinatus , serratus anterior and trapezius muscles , and sometimes the biceps or the diaphragm . Movements such as spreading or lifting the arm are considerably restricted or impossible. Atrophy of the denervated muscles quickly becomes apparent. Sensitivity disorders are usually not very pronounced and can also be absent. A typical picture is a protruding shoulder blade ( scapula alata ) during certain movements.
diagnosis
The examination results are decisive: the supply areas of several spinal nerve roots and several peripheral nerves are always affected. In the electromyography of the deltoid, the signs of the show denervation . The measurement of the nerve conduction velocity also gives pathological values, in extreme cases no signal can be detected. An examination of the cerebrospinal fluid often does not help, but can be useful to rule out differential diagnoses. Basically a blood test is done to rule out a viral infection. In addition, one is magnetic resonance imaging of the cervical vertebrae and the brachial plexus useful to such a herniated disc exclude or other visible causes.
Therapy and prognosis
There is no specific therapy. Painkillers can be used symptomatically. The administration of corticosteroids is controversial. If the shoulder is severely paralyzed, it is important to avoid stiffening due to capsule shrinkage by moving it passively. If the rotator cuff is paralyzed, the shoulder joint may be prone to dislocation or subluxation and should be held in place with a bandage.
The likelihood of a full recovery depends on the healing process in the first few months. If there is no improvement, paralysis is likely in the future. In 3/4 of the cases, however, the disease heals completely within two years. Active support through physiotherapy and targeted, controlled movements with low stress is important. Since it is a paralysis, movement sequences have to be relearned. In this way, the prognosis for an increase in strength in the arms until performance is fully restored is quite good.
literature
- K. Poeck, W. Hacke: Neurology. Springer-Verlag, Berlin 1998, ISBN 3-540-63028-7 .
- Heinz-Walter Delank and Walter Gehlen: Neurology. Thieme Verlag, 2006, ISBN 3-13-129771-9 .
Individual evidence
- ↑ Delank, Heinz-Walter and Walter Gehlen: Neurology . 2006. p. 115.
- ^ Neuralgic amyotrophy. In: Orphanet (Rare Disease Database).
- ↑ Q. Scanvion, T. Perez, F. Cassim, O. Outteryck, A. Lanteri, PY Hatron, M. Lambert, S. Morell-Dubois: neuralgic amyotrophy triggered by hepatitis E virus: a Particular phenotype. In: Journal of neurology. Volume 264, Number 4, April 2017, pp. 770-780, doi : 10.1007 / s00415-017-8433-z , PMID 28247042 (review).
