ABSTRACT
Case Diagnosis: A 59-year-old, previously healthy female. Case Description or Program Description: The patient presented with sudden-onset, severe left posterior shoulder pain. After two days, the pain resolved and she noticed numbness and tingling throughout the left upper extremity and weakness in her left hand. Three weeks prior to symptom onset, the patient experienced COVID-like symptoms but had a negative rapid antigen test. Two weeks prior, the patient received a third COVID-19 vaccination. Cervical spine MRI revealed severe foraminal stenosis at C4-5 and C6-7 and significant central canal stenosis at C6-7, measuring 8.3 mm. MRI imaging of the brain and brachial plexus, as well as upper extremity sonography, were noncontributory. EMG findings suggested a left C5-C6 radiculopathy and a left brachial plexopathy involving the lower trunk. A diagnosis of both cervical radiculopathy and Parsonage Turner Syndrome (PTS) was made, with viral infection followed by vaccination as the suspected etiology. Setting(s): Outpatient PMR Clinic Assessment/Results: A methylprednisone dose-pack, pregabalin 150 mg twice daily, and outpatient physical therapy were prescribed. She was referred to neurosurgery for further evaluation. The patient's symptoms have continued to slowly improve with steroids. Discussion (relevance): The patient's presentation includes a variety of overlying pathology. Posterior shoulder pain, upper extremity numbness and tingling, and hand weakness are common symptoms of radiculopathy and PTS. MRI and EMG confirmed C5-C6 cervical radiculopathy. Clinically, concurrent PTS was diagnosed due to the resolution of shoulder pain, occurring after a viral illness and COVID vaccination, and the improvement of strength without therapy. As COVID-19 vaccination efforts increase, PTS must be considered to maintain a comprehensive differential. Conclusion(s): PTS is a rare neurological condition that is underrecognized. Physiatrists play a critical role in identifying PTS through performing a detailed history, physical exam, and diagnostic studies. As COVIDrelated illness and vaccination rates increase, future studies are needed to explore the frequency of PTS in conjunction with other diagnoses.