Invited Review: Neuralgic amyotrophy: An update in evaluation, diagnosis, and treatment approaches-Article

Article

Pdf Summary

Neuralgic amyotrophy (NA), also known as brachial neuritis or Parsonage-Turner syndrome, is a lesser-known peripheral nerve disorder characterized by extreme pain followed by weakness in specific nerve distributions, often affecting the upper extremities. Previously thought to have a good long-term prognosis, recent studies indicate that many patients face diagnostic delays and continue to experience chronic pain, weakness, and fatigue even years after diagnosis. This review highlights the need for a shift in treatment approaches, focusing on motor coordination, energy conservation, and behavioral changes rather than traditional strength training, which may exacerbate symptoms.<br /><br />Key advancements include the use of advanced imaging, such as neuromuscular ultrasound and magnetic resonance neurography, to detect structural anomalies like hourglass-like constrictions (HGCs), which can confirm diagnosis and guide the need for surgical intervention. These imaging techniques, along with electromyography, help in the early detection and accurate diagnosis of NA by identifying nerve involvement and potential structural causes behind the symptoms.<br /><br />A multidisciplinary healthcare team, featuring neurologists, physical therapists, and occupational therapists, among others, is crucial for addressing the multifaceted symptoms of NA effectively. Initial treatment may involve managing severe pain with corticosteroids, NSAIDs, or neuropathic pain agents. Advanced therapy focuses on improving motor control and managing fatigue through tailored physical and occupational therapy programs.<br /><br />Surgery may be considered for cases with persistent weakness and identified HGCs, but is recommended only after a period of comprehensive conservative management. Further research and collaboration across medical centers are suggested to refine diagnostic criteria and treatment protocols, enhancing the quality of life for patients with NA.

Keywords

Neuralgic amyotrophy

brachial neuritis

Parsonage-Turner syndrome

peripheral nerve disorder

hourglass-like constrictions

advanced imaging

multidisciplinary healthcare

motor coordination

chronic pain

diagnostic delays