Medical Acupuncture
A Journal For Physicians By Physicians

Spring / Summer 1998 - Volume 10 / Number 1
"Aurum Nostrum Non Est Aurum Vulgi"

ABSTRACT 9

ACUPUNCTURE FOR THE TREATMENT
OF PARSONAGE-TURNER SYNDROME:
A CASE STUDY

By Lynn W Yang, M.D. and Henry Chang, MD

INTRODUCTION
     Acupuncture is considered by practitioners of Western medicine to be an alternative method of health care when other options have been exhausted. Acupuncture was the only method of relief for one patient for his left upper extremity pain, after being appropriately treated with analgesics and physical therapy for one year. A case of Parsonage-Tumer Syndrome is further detailed. Acupuncture treatment was chosen for relief of all subjective and objective signs of left arm and shoulder girdle brachial neuritis. With this knowledge, acupuncture may be subsequently used as adjuvant therapy for pain relief in similar patients.

CASE
     A 33-year-old, right-handed Caucasian male awoke one morning in January, 1994, with a left-sided neck and shoulder girdle spasm causing severe pain, which was minimally relieved with a muscle relaxant. The pain radiated from the axilla, both proximally and distally.

PAST HISTORY
     December, 1992, excision of unstable skin and cross finger flap reconstruction; left middle and ring fingers were cut off when he fell on a saw blade. June, 1993, decompression of the left median and u1nar nerves at the left wrist, and decompression and anterior submuscular transposition of the ulnar nerve at the left elbow.

SOCIAL HISTORY

• Employed as a laminator
• Lives at home with a supportive wife
• Smokes one pack of cigarettes per day
• Denies any alcohol or recreational drug usage
• Medications: Lortab (hydrocodone barbiturate and acetominophen), I tablet 3 times a day as needed for pain
• No known drug allergies

DIAGNOSTIC TESTING

• Magnetic resonance imaging (MRI) of the C-spine, T-spine, and chest were normal.
• Electromyogram (EMG) showed decreased recruitment of the left long thoracic nerve.

PERTINENT PHYSICAL FINDINGS

• Visible and palpable spasm over the left shoulder girdle, resulting in visible thoracic scoliosis and left scapular winging.
• Unable to forward flex or abduct without causing spasm.
• Red-purple skin discoloration over area of spasms.
• Weakness of proximal left upper extremity muscles; distal muscle strength normal.
• Decreased pin prick, and light touch sensation in the left upper extremity.

TREATMENT

• 27 sessions in 3 years
• 30 gauge, 1.5 inch needles
• Duration of 15 minutes
• No stimulation
• Points: SI 11, BL 60, HT 7
• Ah-Shi points: SI 9, SI 12, LI 11, LI 16, TH 15, GV 20

CONCLUSION
Outcome / Subjective

• Relief of pain
• Resolution of crampy muscles during movement

FOR ADDITIONAL READING
1. Darby MJ, Wass AR, Fodden DI. Neuralgic amyotrophy presenting to an accident and emergency department. Journal of Accident and Emergency Medicine 1997,14:41-3.
2. Dierckx RA, Ebinger G, Herregodts P, Michotte A, Carly B, Schmedding E, Maillet B. Recurrent brachial plexus neuropathy and giant cell arteritis. Clinical Neurology and Neurosurgery 1990, 92:71-
3. Dyck PJ, Low PA, Stevens JC: Clinical Neurology, Vol 4., Ch 5 1, J13 Lippincott Company, Philadelphia.
4. Ferrini L, Della Torre P, Perticoni G, Cantisani TA. Neuralgic amyotrophy of the shoulder girdle: the Parsonage-Turner Syndrome. Italian Journal of Orthopaedics and Traurnatology 1986, 12:223-3 1.
5. Magee KR, DeJong RN. Paralytic brachial neuritis: discussion of clinical features with review of 23 cases. JAMA 1960,174:10,1258-62.
6. Michotte A, Dierckx R, Deleu D, Herregodts P, Schmedding E, Bruyland M, Ebinger G. Recurrent forms of sporadic brachial plexus neuropa- thy: a report of two cases. Clinical Neurology and Neurosurgery 1988, 90:1, 71-74.
7. Misamore GW, Lehman DE. Parsonage-Tumer Syndrome (acute brachial neuritis). Journal of Bone and Joint Surgery 1996, 78-A:9, 1405-8.
8. Turner JWA, Parsonage MJ. Neuralgic arnyotrophy (paralytic brachial neuritis). Lancet 1957,27:209-212.
9. Parsonage MJ, Turner JW. Neuralgic amyotrophy: the shoulder-girdle syndrome. Lancet 1948;1:973-8.
10. Pieters T, Lambert M, Huaux JP, Nagant DeDeuxchaisnes C. Hemidiaphragmatic paralysis, an unusual presentation of Parsonage-Turner Syndrome. Clinical Rheumatology 1988, 7:3,402-5.
11. Spillane JD. Localised neuritis of the shoulder girdle: a report of 46 cases in the MEE Lancet 1943,2:532-5.
12. Tsairis P, Dyck PJ, Mulder DW. Natural history of brachial plexus neuropathy: report of 99 patients. Archives of Neurology 1972, 27, 109-117.
13. Vanermen B, Aertgeerts M, Hoogmartens M, Fabry G. The syndrome of Parsonage and Turner: discussion of clinical features with a review of 8 cases. Acta Orthopaedica Belgica 1991. 57:4, 414-9.

Henry Chang, M.D.
Surgical Anesthesiology Associates, P.A.
Pavillion of Boorhees
2301 Evesharn Road, Suite 401
Boorhees, NJ 08043
Phone: 609-772-1411