- Departments of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States,
- Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, United States.
Melissa Ming Jie Chua, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States.
DOI:10.25259/SNI_4_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Melissa Ming Jie Chua1, Michael T. Hayes2, Rees Cosgrove1. Parsonage-Turner syndrome following COVID-19 vaccination and review of the literature. 15-Apr-2022;13:152
How to cite this URL: Melissa Ming Jie Chua1, Michael T. Hayes2, Rees Cosgrove1. Parsonage-Turner syndrome following COVID-19 vaccination and review of the literature. 15-Apr-2022;13:152. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11531
Background: Parsonage-Turner syndrome (PTS) is a rare brachial plexopathy characterized by self-limiting shoulder girdle and upper arm pain followed by the upper extremity weakness and sensory changes. While the etiology is not well-understood, the most common cause of PTS is thought to be postviral. There are at least nine reports, to the best of our knowledge, of PTS associated with COVID-19 infection and nine reports associated with COVID-19 vaccination.
Case Description: Here, we present a case of PTS after COVID-19 vaccination in a 64-year-old male and a review of the current literature.
Conclusion: PTS can occur post-COVID-19 vaccination and should be on the differential diagnosis when patient continues to experience shoulder pain and develops weakness or sensory changes in the extremity.
Keywords: COVID-19, Idiopathic brachial neuritis, Parsonage-Turner syndrome, SARS-CoV-2, Vaccine
Parsonage-Turner syndrome (PTS) is a rare upper extremity disorder with an incidence of 1.64/100,000 people. Furthermore, it is known as idiopathic acute brachial neuritis or neuralgic amyotrophy, the syndrome typically involves the upper and middle brachial plexus trunks.[
A 64-year-old previously healthy right-handed senior neurosurgeon with a medical history of hypertension and hyperlipidemia received his first dose of COVID-19 vaccine (mRNA-1273; ModernaTX, Inc.; Cambridge, Massachusetts) without any clinically significant side effects other than transient malaise and fatigue. After his scheduled second COVID-19 vaccine dose administered again into the left deltoid, he experienced mild shoulder soreness and transient rigors in the first 12–24 h. However, 2 weeks postvaccination, he developed intense, unremitting left shoulder girdle pain with associated muscle tenderness that was not relieved with conservative measures such as stretching, heat, or anti-inflammatories (ibuprofen 800 mg Q.I.D.). A week thereafter, he noticed decreased strength and dexterity in the left hand with difficulty opening bottle caps and manipulating small instruments. Within the next few days, he also noted sensory loss with paresthesia and hypoesthesia in the left fourth and fifth digits, as well as on the ulnar aspect of the forearm. His neurologic examination was notable for decreased strength in the left finger extensors (4+/5), particularly in the left fourth and fifth digits, and thenar eminence (4+/5). Reflexes were normal. Sensation was impaired to light touch distally in the left fourth and fifth digits and to a lesser extent in the third digit. Brachial plexitis was suspected and he was started on a steroid taper treatment with prednisone (80 mg/day for 3 days followed by a rapid taper of 20 mg decrease per day to off).
Three weeks after his initial symptom onset, he underwent an electromyogram (EMG) and nerve conduction study (NCS). The right median and right radial sensory nerve action potentials (SNAPs) (unaffected side) had low amplitude, but these were felt to be incidental and related to known prior trauma to that hand. The left median SNAPs were normal, including the lateral and medial antebrachial cutaneous sensory nerves. The left median abductor pollicis brevis compound motor action potentials (CMAPs) were normal as well. The left ulnar SNAP and left ulnar-abductor digiti minimi CMAPs had borderline low amplitude. The left median and ulnar F waves were unremarkable. Needle EMG demonstrated a reduced recruitment pattern in the left extensor indices and left flexor digitorum profundus to digit IV, with increased spontaneous activity in the left first dorsal interosseus. These findings were felt to reflect a mild, patchy, and acute-to-subacute lower trunk brachial plexopathy [
(a-d) Magnetic resonance imaging of the brachial plexus. T1 precontrast (a), T1 postcontrast (b), T2 (c), and STIR (d) demonstrating increased STIR signal, T2-weighted signal, and mild T1 postcontrast enhancement of the medial left scalene muscles along the inferior brachial plexus consistent with inflammatory changes and intramuscular edema (yellow arrows).
Over the course of the next month, there was gradual improvement in finger sensation and strength with near complete resolution by 4 months.
PTS is a rare brachial plexopathy famously described by Parsonage and Turner in 1948, but was first reported by Dreschfeld in 1886.[
EMG, NCS, and MRI can help confirm the diagnosis of PTS.[
There is no consensus on the treatment of PTS, but generally involves conservative measures including analgesia, corticosteroid treatment, and physical therapy.[
At the time of writing, there are only nine other published case reports of PTS post-COVID vaccination [
We present a case of post-COVID-19 vaccination PTS which improved following a corticosteroid taper and conservative measures. This is important as short-term shoulder soreness is a common post-COVID-19 vaccination, however, PTS should be in the differential if a patient continues to experience shoulder pain and develops weakness or sensory changes in the extremity.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
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