Neuralgic amyotrophy
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《神经病学神经外科学杂志》
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Keywords: neuralgic amytrophy
Sir Charles Bell first drew attention to the long thoracic nerve in 1821.1 Lesions of the nerve cause winging of the scapula with medial transition of the scapula and prominence of the vertebral border.2 Skillern in 1913 first observed that the nerve is exposed to trauma in the root of the neck. He wrote:
"The long thoracic nerve is exposed to trauma as it traverses the scalenius medius."
The nerve itself is small in diameter and fragile and is vulnerable at many sites, particularly within the scalenus medius.3
The commonest long thoracic nerve lesion encountered by neurologists is acute brachial plexus neuropathy (neuralgic amyotrophy), which is less common than trauma, accounting for only 5–10% of all cases.4 In 1943, describing 46 patients with "localised neuritis of the shoulder girdle" Spillane5 gave the first full description, elegantly summarised in his renowned text:6
"There is acute onset of pain in the shoulder and side of the neck, over the scapula and down the affected arm usually not further than the elbow...The pain is commonly worse at night, disturbing or preventing sleep...and usually persists for a week or 10 days...little or no general upset, no stiffness of the neck and upper limb reflexes may remain unaltered. After a few days or when the pain is subsiding, paralysis supervenes. The muscles most commonly affected are the serratus, the spinati, the deltoid and the trapezii in that order. The neuritis may be bilateral...Sensory loss is as a rule slight or absent; a small zone of hypo-aesthesia over an affected deltoid muscle...The prognosis is good but affected muscles often waste rapidly and recovery is slow...a year or more. Rarely there may be a recurrence in the same or opposite shoulder."
A year later Aldren Turner7 provided a similar account. The disorder is sometimes named after Parsonage and Turner,8 who provided further examples. In 66 of their original 136 patients, they found possible precipitating causes that included operations, infections, inoculations, and trauma to remote areas. Familial, post-infective (for example influenza, coxsackievirus, infectious mononucleosis, Borrelia burgdorferi) and post-vaccination factors have been described, but the aetiology is unknown in many examples. Meuleman et al suggested that Dreschfeld9 (1885) may have published the first report of hereditary neuralgic amyotrophy, that of a 43 year old woman who had suffered three episodes of painful upper limb weakness and whose sister had suffered seven similar attacks.
A possible earlier example was described as "spontaneous parenchymatous neuritis" in which Joffroy in 1879 showed loss of myelinated fibres.10
References
Bell C . Of the nerves, giving an account of some experiments on their structure and functions, which lead to new arrangement of the system. Philosophical Transactions of the Royal Society of London 1821;111:398–424 Cited in: Norman JM, ed. Garrison & Morton’s Medical Bibliography. 5th edn. Aldershot: Scolar Press 1991;1255:200.
Wiater JM, Flatow EL. Long thoracic nerve injury. Clin Orthop 1999;368:17–27.
Birch R, Bonney G, Wynn Parry CB. Entrapment neuropathy. In: Surgical disorders of the peripheral nerves. New York: Churchill Livingstone, 1998:245–92.
Skillern PG. Serratus magnus palsy with proposal of a new operation for intractable cases. Ann Surg 1913;57:909–15.
Spillane JD. Localised neuritis of the shoulder girdle. Lancet 1943;ii:532–5.
Spillane JD. An atlas of clinical neurology. Oxford: Oxford University Press, 1968:134–5.
Turner JWA. Acute brachial radiculitis. BMJ 1944;2:592–4.
Parsonage MJ, Turner JWA. Neuralgic amyotrophy: the shoulder-girdle syndrome. Lancet 1948;1:973–8.
Dreschfeld J . On some rarer forms of muscular atrophies. Brain 1885;8:164–90.
Joffroy A . De la névrite parenchymateuse spontanée, géneralisée ou partielle. Archives Physiol, Norm Path 1879;6:172–98.(J M S Pearce)
Keywords: neuralgic amytrophy
Sir Charles Bell first drew attention to the long thoracic nerve in 1821.1 Lesions of the nerve cause winging of the scapula with medial transition of the scapula and prominence of the vertebral border.2 Skillern in 1913 first observed that the nerve is exposed to trauma in the root of the neck. He wrote:
"The long thoracic nerve is exposed to trauma as it traverses the scalenius medius."
The nerve itself is small in diameter and fragile and is vulnerable at many sites, particularly within the scalenus medius.3
The commonest long thoracic nerve lesion encountered by neurologists is acute brachial plexus neuropathy (neuralgic amyotrophy), which is less common than trauma, accounting for only 5–10% of all cases.4 In 1943, describing 46 patients with "localised neuritis of the shoulder girdle" Spillane5 gave the first full description, elegantly summarised in his renowned text:6
"There is acute onset of pain in the shoulder and side of the neck, over the scapula and down the affected arm usually not further than the elbow...The pain is commonly worse at night, disturbing or preventing sleep...and usually persists for a week or 10 days...little or no general upset, no stiffness of the neck and upper limb reflexes may remain unaltered. After a few days or when the pain is subsiding, paralysis supervenes. The muscles most commonly affected are the serratus, the spinati, the deltoid and the trapezii in that order. The neuritis may be bilateral...Sensory loss is as a rule slight or absent; a small zone of hypo-aesthesia over an affected deltoid muscle...The prognosis is good but affected muscles often waste rapidly and recovery is slow...a year or more. Rarely there may be a recurrence in the same or opposite shoulder."
A year later Aldren Turner7 provided a similar account. The disorder is sometimes named after Parsonage and Turner,8 who provided further examples. In 66 of their original 136 patients, they found possible precipitating causes that included operations, infections, inoculations, and trauma to remote areas. Familial, post-infective (for example influenza, coxsackievirus, infectious mononucleosis, Borrelia burgdorferi) and post-vaccination factors have been described, but the aetiology is unknown in many examples. Meuleman et al suggested that Dreschfeld9 (1885) may have published the first report of hereditary neuralgic amyotrophy, that of a 43 year old woman who had suffered three episodes of painful upper limb weakness and whose sister had suffered seven similar attacks.
A possible earlier example was described as "spontaneous parenchymatous neuritis" in which Joffroy in 1879 showed loss of myelinated fibres.10
References
Bell C . Of the nerves, giving an account of some experiments on their structure and functions, which lead to new arrangement of the system. Philosophical Transactions of the Royal Society of London 1821;111:398–424 Cited in: Norman JM, ed. Garrison & Morton’s Medical Bibliography. 5th edn. Aldershot: Scolar Press 1991;1255:200.
Wiater JM, Flatow EL. Long thoracic nerve injury. Clin Orthop 1999;368:17–27.
Birch R, Bonney G, Wynn Parry CB. Entrapment neuropathy. In: Surgical disorders of the peripheral nerves. New York: Churchill Livingstone, 1998:245–92.
Skillern PG. Serratus magnus palsy with proposal of a new operation for intractable cases. Ann Surg 1913;57:909–15.
Spillane JD. Localised neuritis of the shoulder girdle. Lancet 1943;ii:532–5.
Spillane JD. An atlas of clinical neurology. Oxford: Oxford University Press, 1968:134–5.
Turner JWA. Acute brachial radiculitis. BMJ 1944;2:592–4.
Parsonage MJ, Turner JWA. Neuralgic amyotrophy: the shoulder-girdle syndrome. Lancet 1948;1:973–8.
Dreschfeld J . On some rarer forms of muscular atrophies. Brain 1885;8:164–90.
Joffroy A . De la névrite parenchymateuse spontanée, géneralisée ou partielle. Archives Physiol, Norm Path 1879;6:172–98.(J M S Pearce)