Parsonage-Turner Syndrome Following COVID-19 Exposures: A Systematic Review

Abstract

Background:

Parsonage-Turner syndrome (PTS) is an uncommon neuropathy classically characterized by acute onset shoulder pain followed by muscle weakness and usually eventual resolution. In the post-COVID-19 era with large portions of the population experiencing viral infection and vaccination, multiple case reports of PTS surfaced in medical literature, with only 1 case report in hand literature.

Methods:

A systematic review was performed using PubMed, Embase, Scopus, Web of Science, and Google Scholar to identify all reported cases of PTS related to COVID-19 infection or vaccination. Trends in diagnostic modalities and treatment options were recorded.

Results:

Thirty-two reports on 54 patients were identified detailing PTS cases following COVID-19 vaccination, and 21 reports on 26 patients following COVID-19 infection. Patients presented an average of 9.5 days following vaccination versus 18.8 days postinfection. Magnetic resonance imaging (MRI) was performed on 82.5% of patients, with the most common findings being normal, hourglass-like constrictions, intramuscular edema on T2-weighted images, and enlargement of regional lymph nodes. Seventy-nine percent (79%) of patients had nerve conductive study (NCS) and electromyography (EMG) performed an average of 6.6 weeks following musculoskeletal symptom onset.

Conclusions:

As more patients are routinely vaccinated against and/or contract COVID-19, an increase of these patients presenting to hand clinics is possible. Electrodiagnostic studies and MRI may best be obtained 2 and 3 weeks, respectively, after symptom onset. In addition, repeat EMG/NCX should be obtained 9 to 12 months after symptom onset to assess if surgical interventions are indicated. Hand surgeons should be prepared to diagnose and institute therapies to optimize recovery.