RESUMO
CASE: Parsonage-Turner syndrome, also known as brachial neuritis or neuralgic amyotrophy, is characterized by sudden-onset pain and subsequent weakness of the shoulder. Known precipitating factors include viral and bacterial infections and certain immunizations. Isolated cases after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. We report the case of a 66-year-old woman with right shoulder dysfunction and medial scapular winging after immunization with the SARS-CoV-2 BNT162b2 vaccine (Pfizer). CONCLUSION: After physical therapy, the patient resumed her normal activities of daily living. Findings from this case represent the first known documentation of Parsonage-Turner syndrome after SARS-CoV-2 BNT162b2 vaccination.
Assuntos
Neurite do Plexo Braquial/etiologia , Vacinas contra COVID-19/efeitos adversos , Idoso , Vacina BNT162 , Neurite do Plexo Braquial/diagnóstico , Neurite do Plexo Braquial/reabilitação , Feminino , Humanos , Modalidades de FisioterapiaAssuntos
Artrogripose/diagnóstico , COVID-19/prevenção & controle , Eletrodiagnóstico/métodos , Neuropatia Hereditária Motora e Sensorial/diagnóstico , Neurite (Inflamação)/diagnóstico , Traumatismos dos Nervos Periféricos/diagnóstico , Artrogripose/reabilitação , Artrogripose/cirurgia , Neurite do Plexo Braquial/diagnóstico , Neurite do Plexo Braquial/reabilitação , Neurite do Plexo Braquial/cirurgia , Gerenciamento Clínico , Cirurgia Geral , Neuropatia Hereditária Motora e Sensorial/reabilitação , Neuropatia Hereditária Motora e Sensorial/cirurgia , Humanos , Controle de Infecções/métodos , Neurite (Inflamação)/reabilitação , Neurite (Inflamação)/cirurgia , Neurologia , Terapia Ocupacional , Traumatismos dos Nervos Periféricos/reabilitação , Traumatismos dos Nervos Periféricos/cirurgia , Modalidades de Fisioterapia , Medicina Física e Reabilitação , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta , SARS-CoV-2 , Telemedicina/métodosRESUMO
BACKGROUND: Neuralgic amyotrophy (NA) is a distinct peripheral neurological disorder of the brachial plexus with a yearly incidence of 1/1000, which is characterised by acute severe upper extremity pain. Weakness of the stabilising shoulder muscles in the acute phase leads to compensatory strategies and abnormal motor control of the shoulder - scapular dyskinesia. Despite peripheral nerve recovery, scapular dyskinesia often persists, leading to debilitating residual complaints including pain and fatigue. Evidence suggests that persistent scapular dyskinesia in NA may result from maladaptive cerebral neuroplasticity, altering motor planning. Currently there is no proven effective causative treatment for the residual symptoms in NA. Moreover, the role of cerebral mechanisms in persistent scapular dyskinesia remains unclear. METHODS: NA-CONTROL is a single-centre, randomised controlled trial comparing specific rehabilitation to usual care in NA. The rehabilitation programme combines relearning of motor control, targeting cerebral mechanisms, with self-management strategies. Fifty patients will be included. Patients are recruited through the Radboud university medical center Nijmegen, the Netherlands. Patients with a (suspected) diagnosis of NA, with lateralized symptoms and scapular dyskinesia in the right upper extremity, who are 18 years or older and not in the acute phase can be included. The primary outcome is the Shoulder Rating Questionnaire score, which measures functional capability of the upper extremity. Secondary clinical outcomes include measures of pain, fatigue, participation, reachable workspace, muscle strength and quality of life. In addition, motor planning is assessed with first-person motor imagery and functional magnetic resonance imaging. In a sub-study the patients are compared to 25 healthy participants, to determine the involvement of cerebral mechanisms. This will enable interpretation of cerebral changes associated with the rehabilitation programme and functional impairments in NA. DISCUSSION: NA-CONTROL is the first randomised trial to investigate the effect of specific rehabilitation on residual complaints in NA. It also is the first study into the cerebral mechanisms that might underlie persistent scapular dyskinesia in NA. It thus may aid the further development of mechanism-based interventions for disturbed motor control in NA and in other peripheral neurological disorders. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03441347 . Registered on 20 February 2018.
Assuntos
Neurite do Plexo Braquial/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto , Autogestão/métodos , Neurite do Plexo Braquial/fisiopatologia , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pacientes Ambulatoriais , Projetos de Pesquisa , Ombro/fisiopatologia , Extremidade Superior/fisiopatologiaRESUMO
El hombro doloroso es un motivo de consulta habitual en Urgencias, Atención Primaria y algunas especialidades. El síndrome de Parsonage-Turner debe formar parte del diagnóstico diferencial de la omalgia aguda. Conocer sus características clínicas y electrofisiológicas nos permitirá evitar iatrogenia. Presentamos 6 casos de síndrome de Parsonage-Turner: un síndrome de etiología desconocida con un cuadro clínico muy característico. Todos comenzaron de forma aguda, con dolor muy intenso de hombro de unas 3 semanas de duración. Tras la resolución de esta primera fase, se evidencia una debilidad marcada del miembro superior con atrofia de los músculos afectados por la neuropatía. Una constante en todos fue el hallazgo de escápula alada. Un caso presentó alteración sensitiva y otro, parálisis hemidiafragmática. Tras la sospecha clínica y la exploración física completa, fueron sometidos a una exploración electromiográfica que confirmó el diagnóstico. Se pautó tratamiento analgésico y rehabilitador
Shoulder pain is a common reason for seeking emergency, primary and specialist care. Parsonage-Turner syndrome should form part of the differential diagnosis of shoulder pain. Familiarity with the clinical and electrophysiological characteristics of this syndrome could help prevent iatrogenic disease. We present 6 cases of Parsonage-Turner syndrome, a syndrome of unknown etiology with a typical clinical picture. All patients had acute onset of the syndrome with intense shoulder pain of approximately 3 weeks' duration. After this phase ended, there was noticeable weakness of the affected arm, causing muscular atrophy depending on the muscles affected by the neuropathy. Winged scapula was present in all patients. One patient showed alteration of sensitivity and another showed hemidiaphragmatic paralysis. After a complete physical examination, the patients underwent electromyographic study that confirmed the diagnosis. Analgesic treatment and rehabilitation were prescribed
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Neurite do Plexo Braquial/diagnóstico , Eletromiografia/métodos , Dor de Ombro/reabilitação , Analgésicos/uso terapêutico , Neurite do Plexo Braquial/reabilitação , Manejo da Dor/métodos , Diagnóstico Diferencial , Escápula/anormalidadesRESUMO
PURPOSE: There is lack of knowledge, evidence, and guidelines for rehabilitation interventions for persons with neuralgic amyotrophy (NA) or brachial plexus pathology. A first pilot study, evaluating the effect of an integrated rehabilitation programme, showed improvements in activity and participation levels. AIM: To gain insight, from the perspective of patients and therapists, into the critical ingredients of the programme, that contributed to improvements in activity and participation. MATERIALS AND METHODS: A qualitative study using semi-structured interviews with eight patients and five therapists (three occupational therapists and two physical therapists). Participants were asked to identify and describe factors regarding the rehabilitation that they perceived as positive and aspects of the programme that could be improved. Data were analysed using a constant comparative approach. RESULTS: Patients reported (1) Time to diagnose: "Finally I'm in the right place;" (2) Awareness: "They gave me a mirror;" (3) Partnership: "There was real contact with the therapists; we made decisions together;" (4) Close collaboration: "Overlapping scopes of practice; doing the same from a different perspective;" and finally (5) Self-management: "Now I can do it myself." Therapists reported (1) "Patients knowledge and understanding is critical to success;" (2) "Activate problem solving and decision making;" (3) "Personalize your therapy; it's more than just giving exercises and information;" (4) "Constant consultation within the team; consistency in messages and approach;" and (5)" Ultimately the patient is in charge." CONCLUSIONS: The critical ingredients, correspond well with each other and include a person-centred approach, education, support in problem solving and decision making and an integrated team approach. These ingredients provided the patients with confidence to take responsibility to manage their everyday lives, the ultimate goal of the programme. Implications for rehabilitation Both patients and therapists believe that the ability to self-manage and take control should be the outcome of high quality integrated rehabilitation programmes for patients with neuralgic amyotrophy and/or other brachial plexus injuries. A person-centred, collaborative, and integrated team approach, among all members of the team, are critical components of care delivery in personalised interventions. Critical programme ingredients are knowledge and education of both the patient and therapists; partnership between patient-therapist and within the team; patient activation and self-reflection; and personalised care. Patients recommend more options for personalisation of the intensity and duration of rehabilitation, the possibility to consult a psychologist and peer support within a group setting.
Assuntos
Neurite do Plexo Braquial/reabilitação , Equipe de Assistência ao Paciente , Adulto , Atitude do Pessoal de Saúde , Plexo Braquial/lesões , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Terapeutas Ocupacionais , Satisfação do Paciente , Assistência Centrada no Paciente , Fisioterapeutas , AutogestãoRESUMO
Neuralgic amyotrophy (NA) is a neurologic syndrome of unknown etiology primarily affecting the brachial plexus. We are reporting an unusual case of acute bilateral NA that was possibly secondary to Lyme disease. The patient demonstrated significant functional gains and was discharged home after 2 weeks of inpatient rehabilitation, supporting the role of inpatient rehabilitation in acute NA. In this report, we discuss the diagnosis, electrodiagnostic progression, pain management, goals for inpatient rehabilitation, and overall prognosis of NA. LEVEL OF EVIDENCE: V.
Assuntos
Neurite do Plexo Braquial/diagnóstico , Pacientes Internados , Doença de Lyme/complicações , Força Muscular/fisiologia , Atrofia Muscular/diagnóstico , Terapia Ocupacional/métodos , Modalidades de Fisioterapia , Idoso , Neurite do Plexo Braquial/complicações , Neurite do Plexo Braquial/reabilitação , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/reabilitação , Masculino , Atrofia Muscular/etiologia , Atrofia Muscular/reabilitação , Recuperação de Função FisiológicaRESUMO
Neuralgic amyotrophy of the shoulder (Parsonage-Turner syndrome) is a rare condition of unknown aetiology which manifests as acute neuropathy of the brachial plexus. Diagnosis is based on typical symptoms and physical examination. In addition, magnetic resonance imaging of the affected shoulder and the cervical spine is advisable, in order to distinguish this syndrome from other conditions with similar symptoms. There is no specific treatment for neuralgic amyotrophy, but in about 50â-â67% of cases complete recovery occurs within two to three years, depending on the severity of the symptoms when they first appear. In patients whose strength and function are not fully restored, neurological deficits may remain, especially if the same shoulder is affected by recurrent attacks.
Assuntos
Neurite do Plexo Braquial/diagnóstico , Doenças Raras , Adulto , Neurite do Plexo Braquial/etiologia , Neurite do Plexo Braquial/reabilitação , Vértebras Cervicais/diagnóstico por imagem , Eletromiografia , Terapia por Exercício , Seguimentos , Predisposição Genética para Doença/genética , Humanos , Imageamento por Ressonância Magnética , Masculino , Exame Neurológico , Exame Físico , Modalidades de Fisioterapia , Fatores de Risco , Manguito Rotador/diagnóstico por imagem , Ombro/diagnóstico por imagem , Resultado do TratamentoRESUMO
BACKGROUND: Cervicobrachial pain (CP) is a high-incidence and prevalent condition. Cervical lateral glide (CLG) is a firstline treatment of CP. There is a current lack of enough high-quality randomized controlled double-blind clinical trials that measure the effectiveness of neural tissue mobilization techniques such as the CLG and its specific effect over CP. OBJECTIVES: The aim of the present study was to assess the effect of CLG neural mobilization in treating subjects who suffer from CP, compared with the complete absence of treatment. STUDY DESIGN: This investigation was a single-center, blinded, parallel randomized controlled clinical trial (RCT). SETTING: One hundred forty-seven individuals were screened in a medical center from July to November 2015. Fifty-eight participants were diagnosed with CP. METHODS: Participants were recruited and randomly assigned into two groups of 29 subjects. The intervention group received CLG treatment, and the control group (CG) was assigned to a six-week waiting list to receive treatment. Randomization was carried out by concealed computer software randomized printed cards. The primary outcome was pain intensity, reported through the Numeric Rating Scale for Pain (NRSP). Secondary outcomes were physical function involving the affected upper limb using the Quick DASH scale and ipsilateral cervical rotation (ICR) using a CROM device. Assessments were made at baseline and one hour after treatment. RESULTS: The CLG group NRSP mean value was significantly (P < 0.0001) superior to those obtained by the CG. Subjects treated with CLG reported an average NRSP decrease of 2.16 points (35%). CROM device and Quick DASH outcome values also reported significant (P < 0.0001) improvements only in the CLG group. Cohen's d showed a very large effect of the CLG intervention at subject discharge. LIMITATIONS: Due to the lack of dipper subgroup analysis and additional reproductions of the applied protocol, the authors considered the generalization of the study results to be impossible. CONCLUSIONS: CLG is superior to the absence of treatment in reducing pain and increasing the affected upper limb function of subjects who suffer from CP. CLG may be considered an effective treatment in specific cases of CP.
Assuntos
Neurite do Plexo Braquial/reabilitação , Cervicalgia/reabilitação , Modalidades de Fisioterapia , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Resultado do Tratamento , Listas de EsperaRESUMO
La neuralgia amiotrófica es una neuropatía infrecuente caracterizada por la aparición de un dolor intenso unilateral en el hombro. Es rara la afectación aislada o concomitante de otros nervios motores periféricos derivados del plexo cervicobraquial, como el nervio frénico o el laríngeo. Su etiología es desconocida, aunque se han planteado varios factores que pueden condicionar su aparición. La afectación del nervio frénico, unilateral o bilateral, es aún más infrecuente. El diagnóstico se basa en la historia clínica, la exploración funcional, técnicas de imagen y en los hallazgos del electromiograma. Presentamos el caso de una mujer de 48 años con antecedentes de trasplante renal por glomerulonefritis proliferativa y rechazo posterior del mismo, que fue definitivamente diagnosticada de neuralgia amiotrófica con afectación frénica bilateral, que precisó ventilación mecánica no invasiva de forma prolongada (AU)
Amyotrophic neuralgia is an uncommon neuropathy characterized by severe unilateral shoulder pain. Isolated or concomitant involvement of other peripheral motor nerves depending on the brachial plexus such as phrenic or laryngeal nerves is unusual. Its etiology is unknown, yet several explanatory factors have been proposed. Phrenic nerve involvement, either unilateral or bilateral, is exceedingly rare. Diagnosis relies on anamnesis, functional and imaging investigations and electromyogram. We report the case of a 48-year-old woman with a past history of renal transplantation due to proliferative glomerulonephritis with subsequent transplant rejection, who was eventually diagnosed with amyotrophic neuralgia with bilateral phrenic involvement, and who required sustained non-invasive mechanical ventilation (AU)
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Neurite do Plexo Braquial/tratamento farmacológico , Neurite do Plexo Braquial/fisiopatologia , Neurite do Plexo Braquial , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Paralisia/complicações , Insuficiência Respiratória/complicações , Analgésicos/uso terapêutico , Neurite do Plexo Braquial/reabilitação , Eletromiografia , Radiografia Torácica , Tomografia Computadorizada de Emissão/métodos , Espirometria/métodos , ImobilizaçãoRESUMO
Objetivo: Esta revisión pretende hacer una puesta al día del síndrome de Parsonage-Turner. Estrategia de búsqueda: Búsqueda bibliográfica consultando las bases de datos: PubMed, Cochrane, Elsevier, Medline, Trip Database y PEDro, hasta enero del 2013. Selección de artículos: De 1.463 artículos, se seleccionaron 176 por responder a los apartados de la revisión que queríamos realizar. Optamos por 46 que nos parecieron los más interesantes para actualizar los conocimientos previos de este síndrome. Intentamos reunir información existente en la literatura científica de utilidad a la hora de diagnosticar y tratar esta afección. Síntesis de resultados: Neuritis braquial o síndrome de Parsonage-Turner caracterizado por dolor agudo en hombro, debilidad, atrofia y déficit sensorial, posteriormente parálisis flácida de la región afectada. Diagnóstico por historia clínica y exploración física, confirmándose con electromiografía y resonancia magnética. Conclusiones: No existe un tratamiento específico, siendo importante la rehabilitación precoz encaminada disminuir el dolor, mantener recorrido articular y combatir atrofia muscular territorios afectados (AU)
Objective: This review aims to present an update on the Parsonage-Turner syndrome. Search strategy: A search was made of the literature, consulting the databases of PubMed, Cochrane, Elsevier, Medline, Trip Database, PEDro until January 2013. Selecting items: Of 1463 articles, 176 that responded to the sections of the review criteria were selected. Of these, 46 were considered as the most interesting to update previous knowledge on this syndrome. An attempt has been made to gather information in the scientific literature that would be useful for diagnosing and treating this condition. Synthesis results: Brachial neuritis or Parsonage Turner syndrome is characterized by acute shoulder pain, weakness, atrophy and sensory deficits later flaccid paralysis of the affected region. Diagnosis is made by medical history and physical examination, confirmed with electromyography and MRI. Conclusions: There is no specific treatment, early rehabilitation important being routed reduce pain, maintain joint range and combat muscle atrophy affected territories (AU)
Assuntos
Humanos , Neurite do Plexo Braquial/reabilitação , Terapia por Exercício/métodos , Articulações/fisiopatologia , Espectroscopia de Ressonância Magnética , EletromiografiaRESUMO
This study characterized the impairments of range of motion, three-dimensional scapulo-thoracic kinematics, isokinetic muscle performance and disability in a patient with Parsonage-Turner Syndrome. The patient had a history of 2.5-years of shoulder pain, and electroneurodiagnostic testing indicative of suprascapular neuropathy. The patient-rated Disabilities of the Arm, Shoulder and Hand (DASH) score was 33.3% (0 = no symptoms/disability), and reduced shoulder internal rotation, external rotation, and flexion as compared bilaterally. There were deficits in isokinetic muscle performance at slow and fast speeds during abduction, lateral and medial rotations as compared to the uninvolved side. Alterations in scapular kinematics were decreased posterior tilt, increased internal rotation, and increased upward rotation during arm elevation and lowering. This information can be used to assist clinicians in developing treatment programs to address the alterations caused by this neuralgic amyotrophy.
Assuntos
Neurite do Plexo Braquial/diagnóstico , Neurite do Plexo Braquial/reabilitação , Avaliação da Deficiência , Escápula/fisiopatologia , Articulação do Ombro/fisiopatologia , Adulto , Fenômenos Biomecânicos , Neurite do Plexo Braquial/complicações , Eletromiografia/métodos , Humanos , Imageamento Tridimensional/métodos , Masculino , Condução Nervosa , Prognóstico , Amplitude de Movimento Articular , Doenças Raras , Índice de Gravidade de Doença , Articulação do Ombro/inervação , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Resultado do TratamentoRESUMO
BACKGROUND: Neuralgic Amyotrophy (NA) is characterized by neuropathic pain, subsequent patchy paresis and possible sensory loss in the upper extremity. Many patients experience difficulties in performing activities of daily life and are unable to resume work. We developed a combined physical- and occupational therapy program for patients recovering from NA. OBJECTIVE: Evaluation of the effectiveness of a multidisciplinary intervention program for patients with subacute NA. METHODS: We performed a within subject proof-of-principle pilot study in eight patients with subacute NA. Patients followed 8 hours of physical and 8 hours of occupational therapy spread over a 16-week period. PRIMARY OUTCOME MEASURES: The Canadian Occupational Performance Measure (COPM) and Shoulder Rating Questionnaire (SRQ). SECONDARY OUTCOME MEASURE: Disability of Arm Shoulder and Hand (DASH). RESULTS: Improvements (mean (95% CI)) were found in the performance and satisfaction scores of the COPM +2.3 (0.9-3.7) and +1.4 (0.4-2.4) points, respectively and the SRQ +14.8 (7.4-22.0) points. The majority of patients (6 out of 8) also demonstrated improvements in the DASH. CONCLUSION: The proposed physical and occupational therapy program, may be effective for patients with subacute NA, as demonstrated by improvements in activity, performance and participation.
Assuntos
Neurite do Plexo Braquial/reabilitação , Terapia Ocupacional/normas , Modalidades de Fisioterapia/normas , Adulto , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Introducción: la neuralgia amiotrófica o síndrome de Parsonage-Turner se asocia a vacunaciones en 15 por ciento de los casos. No existen reportes que vinculen esta condición con la vacuna contra la leptospirosis humana. Objetivo: describir las características clínicas de un paciente que presentó una plexopatía braquial aguda posterior a la inmunización contra la leptospirosis humana. Presentación del caso: un varón de 31 años de edad, obrero agrícola en 2008 recibió una dosis de la vacuna cubana contra la leptospirosis humana (vax-Spiral); 3 semanas después presentó dolor intenso localizado en ambos hombros, a la semana siguiente aparece debilidad muscular y posteriormente atrofia del músculo deltoides derecho. La evaluación neurológica era compatible con afección aguda asimétrica de la porción superior del plexo braquial, con mayor intensidad en el lado derecho, en el cual también estaba involucrado el diafragma. Se comprobó el compromiso de la porción superior del plexo braquial con estudios de neuroconducción y electromiografía. El paciente es tratado con analgésicos y fisioterapia, evolucionando de modo favorable. Conclusiones: el evento ocurrido en este caso sugiere que la vacuna cubana contra leptospirosis humana pudiera producir inmunorreactividad cruzada contra antígenos del sistema nervioso periférico(AU)
Introduction: neuralgic amyotrophy or Parsonage-Turner syndrome is associated with vaccination in 15 percent of cases. There are no reports linking this condition to the vaccine against human leptospirosis. Objective: describe the clinical characteristics of a patient who developed acute brachial plexopathy after vaccination against human leptospirosis. Case presentation: a male 31 year-old agricultural worker received a dose of the Cuban vaccine against human leptospirosis (vax-SPIRAL) in 2008. Three weeks later he presented intense pain in both shoulders. The following week he had muscular weakness, and then atrophy of the right deltoid muscle. Neurological evaluation showed acute asymmetric damage to the upper brachial plexus, with greater intensity on the right side, and involvement of the diaphragm. Nerve conduction examination and electromyography revealed involvement of the upper brachial plexus. The patient was treated with analgesics and physical therapy, and was found to evolve favorably. Conclusions: the events described suggest that the Cuban vaccine against human leptospirosis might produce immunological cross-reactivity against antigens of the peripheral nervous system(AU)
Assuntos
Humanos , Leptospirose/prevenção & controle , Neurite do Plexo Braquial/diagnóstico , Neurite do Plexo Braquial/tratamento farmacológico , Neurite do Plexo Braquial/reabilitação , Vacinação/efeitos adversos , Vacinação/métodosRESUMO
Introducción: la neuralgia amiotrófica o síndrome de Parsonage-Turner se asocia a vacunaciones en 15 por ciento de los casos. No existen reportes que vinculen esta condición con la vacuna contra la leptospirosis humana. Objetivo: describir las características clínicas de un paciente que presentó una plexopatía braquial aguda posterior a la inmunización contra la leptospirosis humana. Presentación del caso: un varón de 31 años de edad, obrero agrícola en 2008 recibió una dosis de la vacuna cubana contra la leptospirosis humana (vax-Spiral); 3 semanas después presentó dolor intenso localizado en ambos hombros, a la semana siguiente aparece debilidad muscular y posteriormente atrofia del músculo deltoides derecho. La evaluación neurológica era compatible con afección aguda asimétrica de la porción superior del plexo braquial, con mayor intensidad en el lado derecho, en el cual también estaba involucrado el diafragma. Se comprobó el compromiso de la porción superior del plexo braquial con estudios de neuroconducción y electromiografía. El paciente es tratado con analgésicos y fisioterapia, evolucionando de modo favorable. Conclusiones: el evento ocurrido en este caso sugiere que la vacuna cubana contra leptospirosis humana pudiera producir inmunorreactividad cruzada contra antígenos del sistema nervioso periférico
Introduction: neuralgic amyotrophy or Parsonage-Turner syndrome is associated with vaccination in 15 percent of cases. There are no reports linking this condition to the vaccine against human leptospirosis. Objective: describe the clinical characteristics of a patient who developed acute brachial plexopathy after vaccination against human leptospirosis. Case presentation: a male 31 year-old agricultural worker received a dose of the Cuban vaccine against human leptospirosis (vax-SPIRAL) in 2008. Three weeks later he presented intense pain in both shoulders. The following week he had muscular weakness, and then atrophy of the right deltoid muscle. Neurological evaluation showed acute asymmetric damage to the upper brachial plexus, with greater intensity on the right side, and involvement of the diaphragm. Nerve conduction examination and electromyography revealed involvement of the upper brachial plexus. The patient was treated with analgesics and physical therapy, and was found to evolve favorably. Conclusions: the events described suggest that the Cuban vaccine against human leptospirosis might produce immunological cross-reactivity against antigens of the peripheral nervous system
Assuntos
Humanos , Leptospirose/prevenção & controle , Neurite do Plexo Braquial/diagnóstico , Neurite do Plexo Braquial/tratamento farmacológico , Neurite do Plexo Braquial/reabilitação , Vacinação/efeitos adversos , Vacinação/métodosRESUMO
OBJECTIVE: To develop recommendations regarding outcome measures and topics to be addressed in rehabilitation for persons with neuralgic amyotrophy (NA), this study explored which functions and activities are related to persisting pain in NA and which questionnaires best capture these factors. DESIGN: A questionnaire-based survey from 2 cross-sectional cohorts, one of patients visiting the neurology outpatient clinic and a cohort seen at a multidisciplinary plexus clinic. SETTING: Two tertiary referral clinics based in the Department of Neurology and Rehabilitation from a university medical center provided the data. PARTICIPANTS: A referred sample of patients (N=248) with either idiopathic or hereditary NA who fulfilled the criteria for this disorder, in whom the last episode of NA had been at least 6 months ago and included brachial plexus involvement. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Two custom clinical screening questionnaires were used as well as the Shoulder Rating Questionnaire-Dutch Language Version, the Shoulder Pain and Disability Index (SPADI), the Shoulder Disability Questionnaire (SDQ), and Overall Disability Sum Score. RESULTS: The survey confirms the high prevalence of persisting pain and impairments. More than half of the patients were restricted by pain, while in those without pain 60% experienced residual paresis. Correlations show an intimate relation between pain, scapular instability, problems with overhead activities, and increased fatigability. A standard physical therapy approach was ineffective or aggravated symptoms in more than 50%. CONCLUSIONS: Pain and fatigue are strongly correlated to persisting scapular instability and increased fatigability of the affected muscles in NA. Our results suggest that an integrated rehabilitation approach is needed in which all of these factors are addressed. We further recommend using the SPADI and SDQ in future studies to evaluate the natural course and treatment effects in NA.
Assuntos
Neurite do Plexo Braquial/reabilitação , Avaliação da Deficiência , Avaliação de Resultados em Cuidados de Saúde , Dor de Ombro/reabilitação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Inquéritos e QuestionáriosAssuntos
Neurite do Plexo Braquial/diagnóstico , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Descompressão Cirúrgica/métodos , Acidentes por Quedas , Adulto , Neurite do Plexo Braquial/reabilitação , Traumatismos Craniocerebrais/diagnóstico , Craniotomia/métodos , Eletroencefalografia/métodos , Eletromiografia/métodos , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Imageamento por Ressonância Magnética/métodos , Regeneração Nervosa/fisiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Cervicobrachial pain is a common cervical spine disorder. It is frequently managed through non-invasive therapy. The objective of this systematic review was to assess effectiveness of non-invasive therapy for the management of cervicobrachial pain, in terms of pain, function and disability. Computerised searches were performed to January 2010. Studies were selected using pre-specified criteria. Methodological quality of included studies was assessed using PEDro and level of inter-reviewer agreement reported using Kappa values. Meta-analyses were conducted on pain scores for similar interventions using DerSimonian-Laird random-effects model to allow for heterogeneity. Effect sizes and 95% confidence intervals were reported. Qualitative analyses, based on Centre for Evidence Based Medicine levels of evidence, were conducted for function and disability. Eleven studies were included in the review. Interventions included general physiotherapy, cervical traction, manual therapy, exercise therapy, and behavioural change approaches. There was inconclusive evidence for the effectiveness of non-invasive management of cervicobrachial pain. Potential benefits were indicated in the provision of manual therapy and exercise and behavioural change approaches to reduce pain. General physiotherapy and traction were no more effective than comparators in reducing pain (level A evidence). Effects of non-invasive management on function and disability were mixed. Future studies should identify which sub-groups of cervicobrachial pain respond to specific interventions.
Assuntos
Neurite do Plexo Braquial/reabilitação , Modalidades de Fisioterapia , Radiculopatia/reabilitação , Adolescente , Adulto , Idoso , Terapia Comportamental , Prática Clínica Baseada em Evidências , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manipulações Musculoesqueléticas , TraçãoRESUMO
A 66-year-old woman with no history of trauma presented with severe shoulder pain. Magnetic resonance imaging revealed rupture of the supraspinatus tendon, for which surgical treatment was considered. However, it was noted that shoulder pain was accompanied by weakness in the shoulder muscles, and the patient underwent electroneuromyographic examination, which revealed neuralgic amyotrophy. Following physical therapy and rehabilitation combined with appropriate medical therapy, her symptoms significantly improved. In cases with severe shoulder pain without a trauma history, characteristics of pain should be thoroughly analyzed and neuralgic amyotrophy considered in the differential diagnosis.