Arm/Shoulder Pain

    
      Re: Arm/Shoulder Pain
    


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Posted by ccf neuro M.D.* on August 27, 1997 at 10:21:56:

In Reply to: Arm/Shoulder Pain posted by Mardee Billingsley on August 22, 1997 at 21:44:33:
  Last June (1996), my husband awoke in the middle of the night with extreme pain in his
  left bicep, elbow and forearm.  After this "attack", he was left with limited muscle strength, if any,
  and the loss of use of his first finger and thumb.  The use of his fingers and minimal strength returned after
  approximately 8 months.  After that he had a similar attack in his right shoulder in August 1996, causing his
  right shoulder blade to wing. This has never returned to normal.  This March 1997, he had another "attack" (all attacks
  are similar, he is asleep and extreme pain for up to two weeks is followed by loss of some nerve or muscle).  This time
  his left shoulder and upper arm were affected, causing him to not be able to move, lift and minimally use any type of shoulder movement for
  5 months.  Although symptoms are gone and motion returned, in all cases, strength was reduced by over 50%.  This morning he
  had another "attack" in his right arm, exactly identical to the very first one, cause loss of finger and thumb use on right hand.  We
  have been to the Virginia Mason clinic in Seattle.  He has been diagnosed with Parsonage-Turner syndrome.  However, this condition is only
  supposed to rarely attack twice almost never three times and certainly never four times.  He has had MRIs, spinal taps, DNA tests, and all forms
  of blood tests.  They have ruled out such things as Lou Gerhig, MS, pressure palsy, etc.  We are basically starting over this coming Tuesday with
  another nuerologist.  Any insight you may have would be appreciated.  If needed you can contact us at [phone].  Thanks
  for any information you can provide.
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Mardee,
Multiple attacks of differing peripheral nerves over time is characteristic of a condition known as mononeuritis multiplex, which is always secondary to some other underlying condition, most often polyarteritis nodosa (a disease that causes inflammation and damage to blood vessels all over the body, including those that send blood to the nerves), sarcoidosis, or diabetes. There are some additional rare congenital chronic neuropathies, and certain immunological disorders, such as cryoglobulinemia, for instance, that can also cause such a syndrome. Parsonage-Turner is a syndrome in which there is painful inflammation of nerves of the brachial plexus, a bundle of nerves in the clavicle region. The individual attacks your husband has had sound just like those seen in this syndrome, however, as you state, it is indeed rare for this condition to recur more than once, especially within such a brief time frame. Thus, your decision to seek reevaluation at this point is probably a good one, since at this point other diagnoses may have to be considered and additional testing done, which might include blood tests, repeat EMG,  and/or nerve biopsy, at your treating neurologist's discretion. Your current and/or new neurologist should be able to get to the bottom of your husband's problem. Treatments are available for many of the conditions that cause this sort of problem. If your husband would be interested in receiving a second opinion from a Cleveland Clinic staff neurologist specifically, the department of neurology's phone number is 1-800-223-2273 extension 45559.
Information that we provide on the neurology forum is intended for general medical informational purposes only. Actual diagnosis and treatment of your husband's specific condition should be strictly in conjunction with his treating physician(s). We hope you find the information provided helpful.