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What is Parsonage Turner Syndrome?

Parsonage-Turner Syndrome (PTS) is a rare condition that affects the nerves in the shoulder and arm. It often begins suddenly, usually with very severe shoulder or arm pain. After the pain eases, people may notice weakness, numbness, or even wasting of muscles in the arm.

What is happening?

In PTS, the problem starts with the nerves that carry signals between the spinal cord and the shoulder/arm muscles. These nerves come together in a network called the brachial plexus.

For reasons that aren’t fully understood, the body’s immune system sometimes mistakenly attacks part of these nerves. This can happen after an infection, vaccination, surgery, or even without any obvious trigger.

When the nerves are irritated or damaged, two things happen:

Pain – when nerves become inflamed, they can send out strong, abnormal pain signals. This explains the sudden, severe pain at the start of PTS.
Weakness and muscle changes – if the nerve cannot carry signals properly, the muscle it controls doesn’t work as it should. Over time, this can lead to weakness and sometimes muscle wasting (called “amyotrophy”).

The good news is that nerves can often heal slowly. As the nerve repairs itself, the muscle usually regains strength, although this can take months or even years.

The Brachial Plexus

Your shoulder and arm are powered by a “network” of nerves called the brachial plexus. Think of it like an electrical wiring system: nerves leave the spinal cord in the neck, come together in a bundle (the plexus), then branch out to control movement and sensation in the shoulder, arm, and hand.

Spinal nerves interconnect and cross through the neck and shoulder into the upper arm. Then the nerves separate into individual nerves controlling specific muscles and recieving sensory signals.

How Does PTS present?

Symptoms
Triggers
Diagnosis
Other causes of shoulder pain

Symptoms

Sudden, severe pain in the shoulder or arm (often starting at night).
Pain that can last for days to weeks.
Weakness in the shoulder, arm, or hand muscles.
Numbness, tingling, or unusual sensations.
In some cases, visible muscle wasting (the muscle looks smaller or thinner).

Triggers

The exact cause isn’t always clear. It can sometimes appear after:

A viral illness.
A vaccination.
Surgery or injury.
Childbirth
Occasionally, it runs in families (genetic form).

In most cases, however, no clear trigger is found.

Diagnosis

Doctors usually diagnose PTS by listening to your story and examining your arm and shoulder. Formal diagnosis can be supported by demonstrating the reduction of nerve impulses down potentially affected nerve with:

Nerve conduction study

A nerve conduction study is a test that checks how well your nerves are working. Small stickers (electrodes) are placed on the skin over a nerve, and a very mild electrical pulse is given. This makes the nerve send a signal, and the machine records how fast and strong that signal is.

If the nerve is healthy, the signal travels quickly and strongly.

If the nerve is damaged (as in Parsonage–Turner Syndrome), the signal may be slower or weaker.

The test may feel a little uncomfortable, like a quick tapping or tingling sensation, but it is safe and usually only takes 20–45 minutes.

Other tests could be done to exclude other possible diagnoses of your shoulder pain. For example:

Shoulder xray
Shoulder MRI
Blood tests

Other common potential causes of your Shoulder Pain

Rotator cuff injury – A tear or inflammation of the muscles and tendons that help move the shoulder. This often causes pain when lifting the arm.
Frozen shoulder (adhesive capsulitis) – Stiffness and pain in the shoulder that gets worse over weeks or months, usually not as sudden or severe at the start as PTS.
Shoulder dislocation or fracture – Usually caused by an accident or fall, leading to sudden pain and loss of movement.
Arthritis flare-up – Pain from “wear and tear” in the shoulder joint (osteoarthritis) or from an inflammatory arthritis (such as rheumatoid arthritis).
Trapped nerve in the neck (cervical radiculopathy) – Pain that starts in the neck and radiates into the shoulder and arm, sometimes with tingling or weakness.
Heart or lung conditions (rare but important) – Pain from angina, a heart attack, or certain lung problems can sometimes be felt in the shoulder or arm. Doctors always consider these in sudden or severe pain.

How is PTS Treated?

There is no instant cure, but treatment focuses on managing symptoms and helping recovery:

Pain relief

Paracetamol & ibuprofen can be tried at first, but often stronger painkillers containing codeine (co-codamol) will need to be substituted.

Other painkillers acting directly on the nerves can be tried, for example gabapentin or amitriptylline.

Steroid Therapy

High dose steroid therapy can be tried in the acute pain phase if appropriate.

There is some small study evidence that early steriod use may reduce time within the acute pain phase and can increase the chance of greater muscle recovery at 1 month, 6 months and 1 year following initial symptoms.

See your family doctor regarding this, however be mindful that they may not have experience with this condition and the need to prescribe high dose steroids (see clinicians page). Steroids do have side effects although less if given in the short term (mood changes, sleep reduction altered blood sugards in diabetics).

Physiotherapy

Physiotherapy is essential to maintain normal range of motion of the shoulder joint and when suitable (likely after the acute pain phase when the weakness is known) to help encourage nerve growth and regaining muscle strength.

Physiotherapy will be ongoing and for many months until full strength can be regained. This is where individual motivation is key as often daily appropriate exercise will be needed as directed by your physiotherapist.

Occupational therapy

Practical advice to how to manage day-to-day tasks both at work and home may be needed to prevent additional injury and maintain function and ability.

Advice on how this condition affects your ability to carry out your employment safely and effectively may need to be obtained.

Recovery

Recovery after PTS can vary a lot depending on how severe the nerve injury is and which nerves are affected. Many patients notice gradual improvement over weeks to months, but full recovery can take several months to over a year.

Factors that influence recovery:

Type of nerve injury: Nerves can be stretched, compressed, or severed. Mild injuries often improve faster, while severe injuries may take longer or be only partially reversible.
Age and overall health: Younger, healthier patients tend to recover more quickly.
Timely treatment: Early physical therapy, controlling swelling, and sometimes surgery can improve outcomes.

Typical progression:

Early weeks: Pain, tingling, or numbness may be prominent. Some muscle weakness may appear.
1–3 months: Numbness and tingling may slowly improve. Weakness may start to recover.
3–12 months: Muscle strength and function usually continue to improve. Some residual numbness or mild weakness can persist.
Long-term: Most people regain meaningful function, but some may have lasting mild sensory changes or reduced strength.

Supportive strategies during recovery:

Physical therapy to maintain muscle strength and flexibility
Occupational therapy for hand or arm function
Pain management if needed (e.g., medications, nerve blocks)
Regular follow-up with your healthcare provider to monitor progress

Key message:

Recovery is often slow, and progress can be gradual. Patience, therapy, and regular medical guidance can maximize your chance of regaining function.

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