Neuralgic amyotrophy isn’t a common condition, and lucky it isn’t! Characterised by severe, acute pain in the shoulder and arm, with weakness, muscle atrophy, and sensory loss soon following, the condition is sudden in its onset, and its causes can be hereditary or idiopathic [1].
While it has been known by many names over the years, and can strike anywhere between the third and seventh decades of life, we know that pain is the first symptom in 90% of cases and it is typically sever and unrelenting. Recovery prognosis is favourable with one third of people experiencing “excellent” recovery by the end of one year and 90% by the end of three years [2]
While a good recovery prognosis is happy news, the severity of the symptoms make it unsurprising that a case of Neuralgic Amyotrophy can have a sudden and severe impact on your life. A recent case report published in the Journal of Contemporary Chiropractic covered the case of a 37-year old male who presented for care with “excruciating bilateral shoulder girdle pain that had localized to his right shoulder and upper arm.” The case report’s authors note that he first presented to his primary care doctor and was provided with pain medication and a steroid pack which achieved some pain reduction but three days following he “lost active range of motion of the right shoulder in abduction at 15 degrees [2].”
Sensory loss and atrophy soon followed in deltoid and supraspinatus muscle groups respectively. Surgery was recommended by a neurosurgeon by the patient “declined and sought chiropractic care [2].”
With such a case, where severe pain and atrophy is noted, a conservative course of care is often selected and this was the case here. This included spinal manipulation to the thoracic spine, cervical flexion distraction, instrument assisted soft tissue manipulation to the muscles surrounding the rotator cuff, and specialised stimulation to the supraspinatus muscles. They also included strengthening exercises for affected muscles at the 8 week mark and vitamin supplementation.
What happened?
Keeping in mind the usual 1-3 year recovery timeframe under usual care, it is encouraging to note that the patients range of motion had improved to 180 degrees of abduction by 6 months.
He was seen for conservative care over 7 months in total, and on an intensive time schedule of 3-4 times per week over the first month only, after which his course of care was tapered to reflect patient needs and outcomes. After 8 weeks of treatment and a 2-week covid shut down, diversified adjustments were included in his care plan (for the cervical spine specifically). At his final re-evaluation, “All strength and range of motion returned and he was able to perform all previous activities of daily living.”
This case study is significant as there is no current global guideline on the treatment for this condition [2]. Additionally, this particular case represents the avoidance of neurosurgery or long term reliance on opioids. While more research is certainly needed, and no big claims or generalisations can be made based on one case report alone, this particular case report gives hope that chiropractic care may be a consideration for the condition. It also begs the question – where does the broader nervous system fit in this type of neuralgia?
It certainly seems like there might be something to see here.
REFERENCES:
- Sathasivam, S., Lecky, B, Manohar, R., and Selvan, A., (2008). Neuralgic Amyotrophy. The Journal of Bone and Joint Surgery. British Volume. Vol 90-B, No. 5 https://doi.org/10.1302/0301-620X.90B5.20411
- Meyers, M., Riddle, R and Johnson K (2022). Conservative chiropractic management of patient with neuralgic amyotophy. Journal of Contemporary Chiropractic. Vol 5, No 1, https://journal.parker.edu/index.php/jcc/article/v
