Sunday, 19 September 2010

MRCP revision battle 15.3: Neuralgic amyotrophy

Neuralgic amyotrophy.  Never heard of it?  Me neither before today, so here are just a few facts to get you through MRCP...

Neuralgic amyotrophy is sometimes also known as brachial plexus neuropathy.

It has a particularly specific presentation:
  • severe pain in shoulder
  • followed by weakness and atrophy of muscles in arms

This presentation alone in an MRCP question should point you towards neuralgic amyotrophy being the answer.  Other clues which would suggest this diagnosis include:
  • preceeded by a URTI
  • decreased or absent reflexes
  • sensory abnormalities

Rarely the diaphragm may also be affected.

There is a risk of shoulder joint subluxation or winging of the scapula.

This link takes you to an image of what just basic neuralgic amyotrophy can look like.

In general it resolves spontaneously in a few months, and treatment is conservative.

After that interesting interlude, lets do battle with the porphyrias...