https://tvgg.be/nl/artikels/meer-dan-gewoon-schouderpijn-neuralgische-amyotrofie-in-beeld

More than just shoulder pain - uncovering neuralgic amyotrophy Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is a collective term for a group of (multi)focal peripheral nerve lesions caused by an immune-mediated inflammatory process. The classic presentation involves sudden, severe shoulder pain, rapidly followed by paresis and muscle atrophy in the upper limb. However, the clinical spectrum is highly variable. Improved understanding of the disease may help clinicians to consider NA from the outset in the differential diagnosis. This would allow for a more targeted use of technical investigations, preventing NA from remaining merely a diagnosis of exclusion, as is often the case now. NA is characterized by inflammation-induced (multi)focal axonal nerve injury, potentially accompanied by focal neural deformities, so-called ‘hourglass constrictions’. This inflammatory process is frequently preceded by physical or immunological stressors. The axonal damage, including its sometimes characteristic distribution, can be demonstrated through targeted electromyographic studies. Advanced imaging modalities may further help in identifying focal neural deformities. An early onset and positive family history should raise suspicion for a hereditary form, which is clinically relevant due to its higher recurrence risk. Long-term spontaneous recovery is generally favorable, making functional rehabilitation and pain management the primary therapeutic goals. Although various other treatment strategies have been reported, most are supported only by anecdotal evidence. This article presents two clinical cases to underscore the underdiagnosed nature of NA and highlight its diverse clinical manifestations.