Invited Review: A standardized ultrasound approach in neuralgic amyotrophy-Article

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Neuralgic amyotrophy, also known as idiopathic brachial plexitis or Parsonage-Turner syndrome, is a peripheral nerve disorder characterized by acute severe shoulder pain followed by progressive weakness and muscle atrophy in the upper limb. Early recognition of neuralgic amyotrophy is important for preventing unnecessary tests and interventions and allowing for prompt treatment. High-resolution ultrasound (HRUS) has become a valuable tool for diagnosing and evaluating the condition. Pathologic HRUS findings in neuralgic amyotrophy can be grouped into four categories: nerve swelling, incomplete constriction, complete constriction, and fascicular entwinement. These findings may represent a continuum of pathological processes and can provide insight into prognosis and the need for surgical intervention. The most frequently affected nerves in neuralgic amyotrophy are the suprascapular, long thoracic, median, anterior interosseous, radial, posterior interosseous, axillary, spinal accessory, and musculocutaneous nerves. When distal upper limb nerves are affected, the lesion is typically located in their respective fascicles within the parent nerve, proximal to its branching point. The authors recommend relying on history and physical examination to determine which nerves should be assessed by HRUS. This review provides a systematic approach for evaluating suspected neuralgic amyotrophy with ultrasound and includes descriptions of scanning techniques for commonly affected nerves. It also discusses the diagnostic and prognostic significance of HRUS findings and the potential role of ultrasound in guiding treatment decisions. Further research is needed to optimize the management of neuralgic amyotrophy and to better understand the diagnostic and prognostic implications of HRUS findings.

Keywords

Neuralgic amyotrophy

idiopathic brachial plexitis

Parsonage-Turner syndrome

shoulder pain

progressive weakness

muscle atrophy

high-resolution ultrasound

pathologic HRUS findings

nerve swelling

surgical intervention