Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Department for Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen at the Eberhard Karls University Tuebingen, Tuebingen, Germany.
J Neurol Neurosurg Psychiatry. 2020 Aug;91(8):879-888. doi: 10.1136/jnnp-2020-323164. Epub 2020 Jun 2.
Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is characterised by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. Recent reports have shown that incidence is much higher than previously assumed and that the majority of patients never achieve full recovery. Traditionally, the diagnosis was mainly based on clinical observations and treatment options were confined to application of corticosteroids and symptomatic management, without proven positive effects on long-term outcomes. These views, however, have been challenged in the last years. Improved imaging methods in MRI and high-resolution ultrasound have led to the identification of structural peripheral nerve pathologies in NA, most notably hourglass-like constrictions. These pathognomonic findings have paved the way for more accurate diagnosis through high-resolution imaging. Furthermore, surgery has shown to improve clinical outcomes in such cases, indicating the viability of peripheral nerve surgery as a valuable treatment option in NA. In this review, we present an update on the current knowledge on this disease, including pathophysiology and clinical presentation, moving on to diagnostic and treatment paradigms with a focus on recent radiological findings and surgical reports. Finally, we present a surgical treatment algorithm to support clinical decision making, with the aim to encourage translation into day-to-day practice.
神经痛性肌萎缩（NA），又称帕森斯-特纳综合征，其特征为突发疼痛发作，随后上肢出现斑片状肌肉无力。最近的报告表明，发病率远高于先前的估计，且大多数患者从未完全康复。传统上，诊断主要基于临床观察，治疗选择仅限于应用皮质类固醇和对症治疗，而对长期结果没有明确的积极影响。然而，这些观点在过去几年受到了挑战。磁共振成像（MRI）和高分辨率超声等改进的成像方法已导致在 NA 中识别出结构周围神经病变，最显著的是沙漏样狭窄。这些特征性发现为通过高分辨率成像进行更准确的诊断铺平了道路。此外，手术已显示可改善此类病例的临床结果，表明周围神经手术作为 NA 的一种有价值的治疗选择具有可行性。在这篇综述中，我们介绍了对这种疾病的最新认识，包括发病机制和临床表现，进而介绍了诊断和治疗模式，重点是最近的影像学发现和手术报告。最后，我们提出了一种手术治疗算法来支持临床决策，旨在鼓励将其转化为日常实践。
