The role of ultrasonography in diagnosis of neuralgic amyotrophy

OBJECTIVE

To investigate the value of high frequency ultrasound in diagnosis of neuralgic amyotrophy.

MATERIALS AND METHODS

From January 2010 to December 2020, the ultrasonographic images of 117 patients with neuralgic amyotrophy diagnosed by the Department of Neurology and hand & foot surgery of Shandong Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed. The ultrasonographic features were summarized.

RESULTS

High frequency ultrasound could clearly show the degree of the affected nerves: No ultrasonic findings were found in 12 cases (10%). The affected nerves were thickening and hypoechogenicity with loss of normal fascicular definition in 28 cases (24%). The affected nerves showed hourglass-like changes, including constriction and torsion in 77 cases (66%). In addition, ultrasound can determine the extent of the lesion, and microvascular imaging can display small blood flow signal within the nerve. There was a significant statistical difference between the diameter of the thickened nerve fascicle and the diameter of the nerve fascicle at the corresponding site of the contralateral normal limb.

CONCLUSIONS

High frequency ultrasound is a valuable imaging method for diagnosis of neuralgic amyotrophy.

Diaphragmatic Dysfunction due to Neuralgic Amyotrophy After SARS-CoV-2 Vaccination: A Case Report

Neuralgic amyotrophy is an idiopathic neuropathy characterized by acute-onset pain, typically in the upper extremity or shoulder, followed by weakness of the associated muscles. Phrenic nerve involvement is rare. We report a 63-year-old man who presented with dyspnea and right shoulder pain after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. His chest radiograph showed an elevated right hemidiaphragm that was absent before vaccination. A pulmonary function test showed a restrictive pattern with a significant reduction (40%) in forced vital capacity in the supine position. Diaphragm ultrasonography revealed a reduction in both diaphragmatic excursion and a thickening fraction of the right hemidiaphragm. Electrophysiological studies suggested a right upper brachial plexopathy. Considering the temporal relationship between the vaccination and absence of other causes, SARS-CoV-2 vaccination was thought to be the reason for neuralgic amyotrophy with diaphragmatic dysfunction. As there was no evidence of hypoventilation or sleep disturbance that may require noninvasive ventilation, the patient was followed with conservative treatment with analgesics. During 8 months of follow-up, his shoulder pain was relieved significantly but dyspnea improved only slightly. Neuralgic amyotrophy is an under-diagnosed etiology of diaphragmatic dysfunction and should be considered in patients with dyspnea and shoulder pain.

The Role of Positional Release Therapy in Treating Recalcitrant Brachial Plexus Neuritis: A Case Report

A 17-year-old female Caucasian soccer player presented with severe right shoulder pain and scapular winging due to brachial plexus neuritis. Over the course of 6 weeks, the patient received Positional Release Therapy once a week coupled with electrical modalities, massage and a daily home exercise program. The form of brachial plexus neuritis the patient was diagnosed with was Parsonage-Turner Syndrome, a rare condition often resistant to traditional physical therapy, typically persists for six months to years, at times requiring surgical intervention. This case report is unique because it is the first to utilize Positional Release Therapy for its treatment and one which resolved more quickly than typically reported.