The surgical treatment of Parsonage-Turner Syndrome: A PRISMA scoping review.

Abstract

Parsonage-Turner Syndrome (PTS) is characterized by an abrupt onset of severe shoulder and upper arm pain followed by motor weakness, muscle atrophy, and sensory disturbances. Although spontaneous recovery is possible, many patients experience prolonged disability. Recent advances in imaging have facilitated the identification of surgically treatable nerve constrictions, prompting interest in surgical interventions including interfascicular neurolysis, decompression, and nerve transfers. This study aims to assess the efficacy of surgical treatment for PTS, delineate optimal patient selection and timing, and compare surgical outcomes with conservative management approaches. A scoping review, adhering to PRISMA guidelines, was conducted using PubMed and Embase databases. Two independent reviewers screened 1,296 articles, with 4 retrospective cohort studies, 1 case series, and 1 case report meeting inclusion criteria. Sample sizes ranged from 1 to 59, and studies were published between 2011 and 2023. Data extracted included study design, sample size, intervention type, outcome measures, and timing of intervention. Results demonstrated that surgical treatment was associated with significant improvements in muscle strength and sensory outcomes. In comparative analyses, patients undergoing surgery exhibited superior recovery relative to those managed conservatively, particularly among younger individuals and those with shorter symptom durations. The average time to surgical intervention was approximately 11 months after symptom onset, with evidence suggesting that earlier surgical management may enhance clinical recovery. This preliminary data suggests that, in carefully selected patients, surgical intervention may have a potential benefit for patients with PTS, particularly for those who fail to respond to conservative management and present early in their disease course. Despite promising outcomes, the limited quality, small sample size, retrospective nature and heterogeneity of the current literature highlight the need for prospective, controlled trials to establish standardized treatment protocols and optimize patient selection.