Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients

Purpose: To review retrospectively the magnetic resonance (MR) imaging findings and clinical information of patients with Parsonage-Turner syndrome (PTS). Materials and Methods: The institutional review board did not require its formal approval or informed patient consent at the time of the study. However, the study was HIPAA compliant. The information in a computerized database of 2875 consecutive shoulder MR examinations was retrospectively reviewed. With use of key terms, the database software identified 81 examinations potentially associated with PTS. Both authors together reviewed the 81 imaging reports and the corresponding patients' medical records. In consensus, they made the diagnosis of PTS in 21 patients ( two with bilateral involvement) on the basis of MR findings, electromyographic results, and clinical data. They also examined the data of an additional six patients ( one with bilateral involvement) obtained from outside facilities. Ultimately, 30 shoulders of 27 patients ( 18 male, nine female; age range, 12 - 81 years; mean age, 41 years) were evaluated. The MR findings and clinical information ( ie, regarding atrophy, pain, weakness, electromyographic results, neck and spine history, trauma, excessive overhead activity, recent surgery, vaccination, and illness) of all patients with PTS were reviewed. MR findings of diffuse high T2 signal intensity abnormality and fatty atrophy of muscles were evaluated to assess the pattern of nerve involvement. Structural causes ( eg, ganglion cyst or other mass) of neurogenic high T2 signal intensity abnormality were excluded at MR imaging. Results: Twenty-nine (97%) of 30 shoulders had suprascapular nerve involvement; in 15 (50%) shoulders, the involvement was limited to this nerve. Fifteen ( 50%) shoulders had axillary nerve involvement; in only one (3%) shoulder, the involvement was limited to this nerve. One shoulder ( 3%) had subscapular nerve involvement. Nine (30%) shoulders demonstrated focal muscular atrophy. Eleven (41%) of 27 patients also underwent electromyography; all of these patients demonstrated neuropathies that matched the patterns of neurogenic high T2 signal intensity abnormality seen at MR imaging. Conclusion: The suprascapular nerve was almost invariably involved ( in 97% of shoulders) in patients with PTS. Axillary nerve involvement also was commonly observed ( in 50% of shoulders). Subscapular nerve involvement was uncommon ( in 3% of shoulders).