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HSS Researchers Identify New Imaging Findings and Treatment for Patients with Parsonage-Turner Syndrome

New York, NY—*October 5, 2016*

Physicians at Hospital for Special Surgery (HSS) have been studying patient outcomes of Parsonage-Turner Syndrome (PTS), an uncommon neurological disorder that results in a sudden paralysis of one or more muscles around the shoulder and arm.

Recent literature1 has shown that PTS affects approximately 1 in 1,000 people annually, which is 30-50 times more than previously estimated.

The majority of patients recover on their own, but those that don’t are afflicted with permanent partial loss of use of their arm. There is a lot of uncertainty around this syndrome as the cause is unknown and each case is different. It occurs spontaneously in otherwise healthy people typically under 50 years of age, with men three times more likely to experience the phenomenon.

“With exciting new MRI and ultrasound imaging protocols, we have identified tiny twists or ‘hourglass’ constrictions inside nerves that were previously healthy, allowing us to diagnose patients more quickly and predict those who may not recover,” said Dr. Scott Wolfe, chief emeritus of Hand and Upper Extremity Service at HSS. “In order to save the affected muscle, we’ve identified surgical techniques that release the nerve and restore function in a matter of months.”

“We are looking to determine what’s different about the patients who have the ability to recover,” said Dr. Steve Lee, research director of the Center for Brachial Plexus and Traumatic Nerve Injury at HSS. “Gathering this data will give answers to patients who may be living with partial paralysis and no medical hope.”

Typically, Parsonage Turner Syndrome is a diagnosis of exclusion as there’s no blood test or biomarker to categorically conclude a patient has PTS. As a result, PTS is often misdiagnosed. The muscles and nerves involved are usually not part of standard diagnostic testing.

“Now that we’ve identified these smaller nerves and can reliably identify abnormalities with MRI, we want to find out why they occur, what they represent in the context of recovery and ultimately how they should be treated,” said Dr. Darryl Sneag, radiologist at HSS.

“Diagnosing patients correctly and sooner is better for all parties,” added Dr. Joseph Feinberg , medical director of the Center for Brachial Plexus and Traumatic Nerve Injury and chief emeritus of Physiatry at HSS. “Electrodiagnostic testing (EMG) helps us accurately diagnose patients and allow us to prognosticate outcome and better direct care. The patient will have peace of mind and can avoid unnecessary extensive testing, which ultimately equates to lower healthcare costs.”

1 van Alfen N, van Eijk JJJ, Ennik T, et al. Incidence of neuralgic amyotrophy (parsonage turner syndrome) in a primary care setting – a prospective cohort study, PLoS One. 2015; 10(5); e0128361

Selected Nerve Articles for Patients. There is additional information on Dr. Wolfe’s nerve research in the About/RESEARCH page

Please call Dr. Wolfe’s office at 212-606-1529 for a copy of any article that interests you.

Nerve Transfers for Enterovirus D68-Associated Acute Flaccid Myelitis: A Case Series.

Saltzman EB, Rancy SK, Sneag DB, Feinberg Md JH, Lange DJ, Wolfe SW.
Pediatr Neurol. 2018 Nov;88:25-30. doi: 10.1016/j.pediatrneurol.2018.07.018. Epub 2018 Aug 20.

A Comparison Between Two Collagen Nerve Conduits and Nerve Autograft: A Rat Model of Motor Nerve Regeneration.

Saltzman EB, Villa JC, Doty SB, Feinberg JH, Lee SK, Wolfe SW.
J Hand Surg Am. 2018 Nov 27.

Brachial plexitis or neuritis? MRI features of lesion distribution in Parsonage-Turner syndrome.

Sneag DB, Rancy SK, Wolfe SW, Lee SC, Kalia V, Lee SK, Feinberg JH.
Muscle Nerve. 2018 Sep;58(3):359-366. doi: 10.1002/mus.26108. Epub 2018 Mar 25.

MRI bullseye sign: An indicator of peripheral nerve constriction in parsonage-turner syndrome.

Sneag DB, Saltzman EB, Meister DW, Feinberg JH, Lee SK, Wolfe SW.
Muscle Nerve. 2017 Jul;56(1):99-106. doi: 10.1002/mus.25480. Epub 2017 Mar 2.

Pins and Needles From Fingers to Toes: High-Resolution MRI of Peripheral Sensory Mononeuropathies.

Deshmukh S, Carrino JA, Feinberg JH, Wolfe SW, Eagle S, Sneag DB.
AJR Am J Roentgenol. 2017 Jan;208(1):W1-W10. doi: 10.2214/AJR.16.16377. Epub 2016 Nov 8. Review.

MRI findings of spinal accessory neuropathy.

Li AE, Greditzer HG 4th, Melisaratos DP, Wolfe SW, Feinberg JH, Sneag DB.
Clin Radiol. 2016 Apr;71(4):316-20. doi: 10.1016/j.crad.2015.11.015

Anatomical Study of the Surgical Approaches to the Radial Tunnel.

Urch EY, Model Z, Wolfe SW, Lee SK.
J Hand Surg Am. 2015 Jul;40(7):1416-20. doi: 10.1016/j.jhsa.

Ultrasound imaging of brachial plexus trauma in gunshot injury.

Nwawka OK, Casaletto E, Wolfe SW, Feinberg JH.
Muscle Nerve. 2019 Jun;59(6):707-711. doi: 10.1002/mus.26461.

Nerve transfers for the upper extremity: new horizons in nerve reconstruction.

Lee SK, Wolfe SW.
J Am Acad Orthop Surg. 2012 Aug;20(8):506-17. doi: 10.5435/JAAOS-20-08-506. Review.

Electrodiagnostic evidence of suprascapular nerve recovery after decompression.

Feinberg JH, Mehta P, Gulotta LV, Allen AA, Altchek DW, Cordasco FA, Potter HG, Warren RF, Wickiewicz TL, Wolfe SW.
Muscle Nerve. 2019 Feb;59(2):247-249.

The electrodiagnostic natural history of parsonage-turner syndrome.

Feinberg JH, Nguyen ET, Boachie-Adjei K, Gribbin C, Lee SK, Daluiski A, Wolfe SW.
Muscle Nerve. 2017 Oct;56(4):737-743. doi: 10.1002/mus.25558. Epub 2017 Apr 13.

Peripheral nerve injury and repair.

Lee SK, Wolfe SW.
J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):243-52. Review.

Long-nerve grafts and nerve transfers demonstrate comparable outcomes for axillary nerve injuries.

Wolfe SW, Johnsen PH, Lee SK, Feinberg JH.
J Hand Surg Am. 2014 Jul;39(7):1351-7. doi: 10.1016/j.jhsa.2014.02.032. Epub 2014

Ulnar neuropathy at the wrist.

Pearce C, Feinberg J, Wolfe SW.
HSS J. 2009 Sep;5(2):180-3; quiz 184-5. doi: 10.1007/s11420-009-9110-2.

In addition to Brachial Plexus repair, Dr. Wolfe regularly treats the following nerve disorders of the upper extremities:

Wrist Hand Nerve Elbow
Scott Wolfe, MD
Upper Extremity Surgeon
Dr. Scott Wolfe is an internationally recognized Hand and Peripheral Nerve Surgeon.
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