title: Typical brachial neuritis (Parsonage-Turner syndrome) with hourglass-like constrictions in the affected nerves.
abstract: OBJECTIVE
  To report on 5 patients who had acute brachial neuritis (Parsonage-Turner syndrome) with hourglass-like constriction in the affected nerves.
  
  
  METHODS
  We retrospectively reviewed 5 patients who were treated in our department from December 2003 to December 2008. Acute, intense pain around the shoulder girdle and upper arm was the first symptom and was followed by muscle weakness and atrophy. Clinical and EMG examinations showed involvement of 2 or more nerves in the affected extremity. Those severely affected nerves that had no response to conservative treatment were explored, and an hourglass-like constriction was identified. Neurolysis was performed at the sites of constrictions in 2 radial nerves and 1 median nerve. The constricted portion was resected, and direct coaptation was performed in 1 radial nerve and 1 musculocutaneous nerve. The constricted portion was resected, and nerve graft was performed in 2 radial nerves and 1 median nerve.
  
  
  RESULTS
  All patients were followed up for 24 to 84 months after surgery. Of 3 nerves treated with external neurolysis, all attained full recovery. Of 2 nerves treated with resection and neurorrhaphy, 1 attained full recovery, and the other had an incomplete recovery. Of 3 nerves treated with resection and nerve graft, 1 (4-cm nerve graft) attained full recovery, and 2 (4-cm and 13-cm nerve graft, respectively) had incomplete recovery.
  
  
  CONCLUSIONS
  The site of nerve lesion of brachial neuritis was not necessarily within the brachial plexus. Our finding of hourglass-like constrictions in individual peripheral nerves suggest that multifocal involvement of terminal branch lesions may underlie the complex patterns of paralysis often encountered clinically.
  
  
  METHODS
  Prognostic IV.
authors: Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China. panyongwei@yahoo.com.cn
authors: Yong-Wei
authors: YW
authors: Pan
authors: Shufeng
authors: S
authors: Wang
authors: Guanglei
authors: G
authors: Tian
authors: Chun
authors: C
authors: Li
authors: Wen
authors: W
authors: Tian
authors: Mengmeng
authors: M
authors: Tian