Pain
Rocco Romeo, DO
Resident Physician
HCA/UCF West Florida
Pensacola, Florida, United States
Susan Belcher, MD
Program Director
UCF/HCA Physical Medicine & Rehabilitation Residency
Pensacola, Florida, United States
Rocco Romeo, DO
HCA/UCF West Florida
Pensacola, Florida, United States
Significant pain and subsequent debility in a patient with a brachial plexopathy following Pilates.
Case Description:
A 46-year-old female presented to an outpatient physical medicine and rehabilitation/interventional pain clinic in acute stress with exquisite pain in left shoulder following multiple emergency department (ED) visits in the days preceding her appointment. Her pain started 12 hours following Pilates and was described as sharp and constant at rest and worsened with use of her left upper extremity. She also experienced insomnia due to pain as well as allodynia. Computed tomography (CT) of the head and neck performed at the ED was unremarkable. Outpatient electromyography (EMG) and magnetic resonance imaging (MRI) were also unremarkable. The patient received some mild relief from trigger point injections and pregabalin. After two weeks from initial presentation, pain went from sharp to achy in the left shoulder area with the right shoulder area now presenting as sharp pain similar to the left shoulder at initial presentation.
Discussions:
Parsonage-Turner Syndrome, an uncommon neurological disorder characterized by rapid onset of severe pain in the arm and shoulder, was suspected. The combination of clinical presentation, response to clinical course, and lack of early remarkable diagnostic findings was convincing for diagnosis. The patient’s pain slowly resolved over time without the need for escalating interventions.
Conclusions:
Plexopathies, especially involving upper extremity anatomy, can be incredibly painful and debilitating. Given the presentation of acute distress with pain out of proportion following a seemingly innocuous inciting event (or lack thereof), patients and providers may be inclined to consider more acute workups, interventions, and treatments. There is no current case study of Parsonage-Turner following Pilates. Awareness of clinical presentation after activities such as Pilates is paramount to prevent unnecessary medications, imaging, procedures, and concern for patients.
