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Invited Review: Neuralgic amyotrophy: An update in evaluation, diagnosis, and treatment approaches
Invited Review: Neuralgic amyotrophy: An update in evaluation, diagnosis, and treatment approaches
FREE MEMBER CME!

Abstract
Neuralgic amyotrophy (NA) is an underrecognized peripheral nerve disorder distinguished by severe pain followed by weakness in the distribution of one or more nerves, most commonly in the upper extremity. While classically felt to carry a favorable prognosis, updates in research have demonstrated that patients frequently endure delay in diagnosis and continue to experience long term pain, paresis, and fatigue even years after the diagnosis is made. A transition in therapeutic approach is recommended and described by this review, which emphasizes the necessity to target compensatory abnormal motor control and fatigue by focusing on motor coordination, energy conservation strategies, and behavioral change, rather than strength training which may worsen the symptoms. The development of structural hourglass-like constrictions (HGCs) on imaging can help confirm the suspected clinical diagnosis, and in association with persistent weakness and limited recovery on electrodiagnostic testing may be considered for surgical consultation. Given the complex nature of management, a multidisciplinary approach is described, which can provide an optimal level of care and support for patients with persistent symptoms from NA and allow more unified guidance of rehabilitation and surgical referrals.


Objectives:
1) Know how to perform an efficient and effective physical examination and electrodiagnostic evaluation of patients with suspected neuralgic amyotrophy; 2) Understand the role of advanced imaging in the evaluation of patients with suspected neuralgic amyotrophy, and be able to order appropriate magnetic resonance neurography; 3) Understand and appropriately implement physical therapy, occupational therapy, multidisciplinary care and, if needed, surgical referrals for patients with neuralgic amyotrophy, and neuromuscular ultrasound evaluations.

ACCREDITATION STATEMENT
The AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CREDIT DESIGNATION
The AANEM designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

DISCLOSURE INFORMATION
The authors have no conflicts to disclose.

FORMAT
PDF
Author
Joelle M. Gabet MD;  Noriko Anderson MD, MPH; Jan T. Groothuis MD, PhD; Evan R. Zeldin MD; John W. Norbury MD; Andrew S. Jack MD, MSc, FRCSC; Line Jacques MD, MSc, FRCSC; Darryl B. Sneag MD; Ann Poncelet MD
Summary
Availability: On-Demand
Expires on Oct 11, 2027
Cost: Member: $0.00
Non-Member: $25.00
Credit Offered:
1 CME Credit
1 CEU Credit


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