Rehabilitation Potential in Lymphoma Associated Paralytic Brachial Neuritis/ Parsonage Turner Syndrome

Case Diagnosis: 64 year old male with malignancy associated Paralytic Brachial Neuritis/ Parsonage Turner Syndrome

Case Description or Program Description: Patient presented with progressive cervical radiculopathy, associated with extra nodal Natural Killer T-cell lymphoma, treated with steroids and chemotherapy. Physical exam demonstrated pain and reduced range of motion of the right upper extremity. Initial cervical MRI was normal, but NCS / EMG showed evidence of focal demyelinating process of the median nerve at the right wrist, considered severe carpal tunnel syndrome. Two months later he continued with worsening right upper extremity pain and weakness. Repeat MRI showed metastatic disease to right cervical nerve roots, extending into trunks and proximal divisions of the brachial plexus.

Setting: Inpatient Rehabilitation Center for interdisciplinary rehabilitation

Assessment/Results: Patients therapy was focused on right upper extremity range of motion, strength training and utilization of NMES. After two weeks, the patient showed clinical evidence of distal muscle motor test improvement. He was followed closely after discharge. Two months post discharge, patient has regained full range of motion and strength of wrist and fingers, elbow flexion and extension, with persistent moderate deficits of right shoulder motion and strength.

Discussion (relevance): Parsonage-Turner syndrome is a rare neurologic disease that commonly presents with acute severe proximal pain followed by progressive weakness. Although there are no specific rehabilitation guidelines to preserve motor function in these patients, this case study demonstrates the benefits of acute multidisciplinary therapy in restoring functionality. This patient initiated rehabilitation approximately 5 months after the initial onset. In this case, initiating rehabilitation during the subacute phase of the condition allowed for a clinically significant improvement in strength and function. However, we should consider the negative impact of delaying rehabilitation, since strengthening exercises to completely dennervated muscles may overload muscles undergoing reinnervation.

Conclusions: Further research is required to identify the rehabilitation strategies to assist in recovery of this rare debilitating condition.