gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

The Role of Neurolysis for Hourglass Constrictions in Chronic Parsonage-Turner Syndrome

Meeting Abstract

  • presenting/speaker Scott Wolfe - Hospital for Special Surgery, New York, United States
  • Karthik Krishnan - Hospital for Special Surgery, New York, United States
  • Darryl Sneag - Hospital for Special Surgery, New York, United States
  • Joseph Feinberg - Hospital for Special Surgery, New York, United States
  • Ogonna Nwawka - Hospital for Special Surgery, New York, United States
  • Steve Lee - Hospital for Special Surgery, New York, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-788

doi: 10.3205/19ifssh0805, urn:nbn:de:0183-19ifssh08050

Published: February 6, 2020

© 2020 Wolfe et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Wide variability in recovery of patients affected by Parsonage-Turner syndrome (PTS) is now recognized, with up to 60% experiencing residual motor deficits or pain. Using high-resolution MRI and ultrasound (US), we routinely identify hourglass constrictions (HGCs) in affected nerves of patients with persistent motor paralysis from PTS. We hypothesized that patients with chronic PTS and HGCs would experience motor recovery and functional improvement following microsurgical epi- and perineurolysis of the constrictions.

Methods: Eight patients (3 F), ages 21-61 years, with chronic motor palsy from PTS and HGCs were treated with microsurgical epi- and peri-neurolysis of HGCs. Average time from symptom onset to surgery was 12.0 ± 4.7 months. Preoperative electrodiagnostic (EDX) testing and manual motor testing confirmed complete muscle denervation in the distribution of affected nerve(s). HGCs were identified in one or more nerves in all patients using 3.0 T MRI and US. Microneurolysis was indicated for the following: failure to improve clinical and EDX function after 6 months with 3 successive exams, each at least 6 weeks apart (n = 3), or 12 months without improvement since symptom onset (n = 5). Muscle strength was assessed pre-and postoperatively using the modified Medical Research Council (MRC) scale and EDX.

Results and Conclusions: Average postoperative clinical and EDX follow-up was 13 months (range, 4-29) and included data on 27 of 29 affected muscles. Thirty HGCs in 11 nerves were identified on imaging and confirmed intra-operatively, involving the pronator teres and anterior interosseous fascicles of the median nerve, suprascapular, axillary and radial nerves proper. One patient presented with bilateral disease. 7/8 patients experienced functional recovery and 6/8 experienced electrical recovery in the majority of affected muscles. Average MRC increased from 0.5 ± 1.1 to 3.3 ± 1.6 among the 7 patients with unilateral disease and from 0.3 ± 1.0 to 2.5 ± 2.0 for the entire cohort (p<0.01). EMG revealed significant motor unit recovery from axonal regeneration in 16/28 muscles (p<0.01). Microsurgical epi- and peri-neurolysis of HGCs in this small cohort was associated with significant electrical and functional muscle recovery at an average follow-up of 9.5 months. We recommend microsurgical epi- and perineurolysis of HGCs for patients with PTS motor palsy who fail to improve with non-operative treatment.