Bang MH, Song HL, Hahn S, Kim W, Do HK. Neuralgic amyotrophy with hourglass-like constrictions: A case report. World J Clin Cases 2024; 12(34): 6728-6735 [DOI: 10.12998/wjcc.v12.i34.6728]
Corresponding Author of This Article
Hwan-Kwon Do, MD, Chief Physician, Department of Physical Medicine and Rehabilitation, Dongnam Institute of Radiological and Medical Sciences, 40 Jwadong-gil, Jangan-eup, Gijang-gun, Busan 46033, South Korea. satirev@dirams.re.kr
Research Domain of This Article
Rehabilitation
Article-Type of This Article
Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 6, 2024; 12(34): 6728-6735 Published online Dec 6, 2024. doi: 10.12998/wjcc.v12.i34.6728
Neuralgic amyotrophy with hourglass-like constrictions: A case report
Mi-Hyeon Bang, Ha-Lim Song, Seok Hahn, Wanil Kim, Hwan-Kwon Do
Mi-Hyeon Bang, Ha-Lim Song, Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
Seok Hahn, Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
Wanil Kim, Division of Biochemistry, Department of Convergence Medical Science, Institute of Medical Science, Gyeongsang National University College of Medicine, Jinju 52727, South Korea
Hwan-Kwon Do, Department of Physical Medicine and Rehabilitation, Dongnam Institute of Radiological and Medical Sciences, Busan 46033, South Korea
Author contributions: Bang MH was responsible for the revision of the manuscript and contributed to manuscript drafting; Hahn S reviewed magnetic resonance imaging, and selected the figures; Do HK reviewed the literature, contributed to manuscript conceptualization and revision; Kim W and Song HL reviewed the literature.; all of the authors read and approved the final version of the manuscript to be published.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose. This work was not supported by agencies in the public, commercial, or not-for-profit sectors.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hwan-Kwon Do, MD, Chief Physician, Department of Physical Medicine and Rehabilitation, Dongnam Institute of Radiological and Medical Sciences, 40 Jwadong-gil, Jangan-eup, Gijang-gun, Busan 46033, South Korea. satirev@dirams.re.kr
Received: June 25, 2024 Revised: September 11, 2024 Accepted: September 25, 2024 Published online: December 6, 2024 Processing time: 109 Days and 3 Hours
Abstract
BACKGROUND
Neuralgic amyotrophy (NA) is a rare disease with sudden upper limb pain followed by affected muscle weakness. The most commonly affected area in NA is the upper part of the brachial plexus, and the paraspinal muscles are rarely affected (1.5%), making these cases difficult to distinguish from cervical radiculopathy.
CASE SUMMARY
A 76-year-old male presented to the emergency department with left hip pain post-fall. After undergoing left femoral neck fracture surgery, he experienced sudden left shoulder pain for 10 days with subsequent left arm weakness. Cervical spine computed tomography revealed mild right asymmetric intervertebral disc bulging with a decreased C5-6disc space. Three weeks later, an electrodiagnostic study confirmed brachial plexopathy findings involving the cervical root. Magnetic resonance neurography was performed for a differential diagnosis. Contrast enhancement was identified at the upper trunk of the brachial plexus, including the C5 nerve root. A suprascapular nerve hourglass-like focal constriction (HLFC) was also identified, confirming NA. After being diagnosed with NA, the patient received 15 mg prednisolone, twice daily, for 3 weeks. Physical therapy was initiated, including left arm strengthening exercises and electrical stimulation therapy. Left shoulder muscle strength significantly improved one month after comprehensive rehabilitation.
CONCLUSION
NA's unique features like HLFC and paraspinal involvement are crucial for accurate diagnosis, avoiding confusion with cervical radiculopathy.
Core Tip: Neuralgic amyotrophy (NA) can closely mimic cervical radiculopathy, leading to potential misdiagnosis. This report presents a 76-year-old male with sudden onset shoulder pain and arm weakness, initially suspected as cervical radiculopathy. Electrodiagnostic studies and magnetic resonance neurography revealed characteristic NA findings, including suprascapular nerve hourglass-like focal constriction. Accurate diagnosis enabled timely treatment with corticosteroids and physical therapy, resulting in significant recovery. This case underscores the importance of distinguishing NA from similar conditions for effective management.
