Gentle exercises for Parsonage Turner

Ann Cools, Clinical Pearls / Friday, July 19th, 2019

Parsonage-Turner syndrome (PTS) is an uncommon neurological disorder characterized by rapid and idiopathic onset of severe pain in the shoulder and arm. It involves mainly the plexus brachialis and/or the n. thoracicus longus or accessorius. Often the patient reports getting up in the morning with a painful arm and a substantial scapular malpositioning (“I felt when I was sitting on a chair for breakfast my shoulder blade pushing against the chair”).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. Additional symptoms include absent or reduced reflexes and sensory deficits in the affected areas such as hypoesthesia, paresthesia or dysesthesia (numbness, tickling, burning…). The underlying cause of PTS is not fully understood. Different factors, including immunologic, environmental, and genetic ones, are thought to play a role in the development of the disorder. A recent viral illness  is a common ‘triggering’ factor associated with the development of the disorder.

There is no specific treatment for PTS, and the slow natural course of the disease should be taken into account. Rehabilitation guidelines consist of pain education and ADL advise in the early stages, and gentle exercise therapy in the more chronic phase. Like in any peripheral neurological disorder of the upper extremity, recovery cannot be “pushed” by stringent exercises, and we should follow the natural healing process with a well-balanced home-exercise program. In case of scapular dysfunction, the most appropriate exercises are elevation exercises with minimal influence of gravity, like bench slides (figure 1) and wall slides (figure 2). Additionally sidelying exercises (figure 4) seem to minimize abnormal scapular position. Often high elevation exercises like overhead shrugging (figure 3) result in better scapular position than midrange movements.

Figure 1

Final advise: be careful not to push your patient towards Dr Google, where the “worst case scenarios” are often highlighted. In other words: communicate efficiently, and give your patient positive but realistic expectations.

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