Attempted Restoration of Elbow Flexion in Suspected Parsonage-Turner Syndrome Using the Oberlin Procedure: A Case...

Parsonage-Turner syndrome (PTS) can present with upper extremity weakness that overlaps clinically with traumatic upper-trunk brachial plexus injury, cervical radiculopathy, and shoulder pathology. Although many patients improve with conservative management, persistent paralysis of elbow flexion after a defined period of observation creates a difficult management decision. In selected patients with preserved donor nerve function and no evidence of meaningful reinnervation, distal nerve transfer may be considered to attempt restoration of elbow flexion. A 58-year-old right-hand-dominant man developed progressive right upper extremity weakness after a skiing accident in which he fell onto his right shoulder and was initially diagnosed with a rotator cuff tear. He later sustained a second fall onto his left palm. The differential diagnosis included traumatic upper-trunk brachial plexus injury, cervical radiculopathy related to prior cervical surgery, rotator cuff pathology, recurrent tendon injury, and PTS or idiopathic brachial neuritis. Suspicion for PTS was supported by delayed progression of weakness after the inciting event, absence of a compressive cervical lesion, electrodiagnostic denervation in the musculocutaneous distribution, and preserved median and ulnar donor function. Although he reported dropping objects and difficulty using the right hand during daily tasks, formal distal motor testing showed preserved finger flexion and abduction. After six months of observation and therapy without recovery of antigravity elbow flexion, surgical exploration was performed. A double fascicular transfer was completed using the flexor carpi radialis fascicle of the median nerve to the biceps branch of the musculocutaneous nerve and the flexor carpi ulnaris fascicle of the ulnar nerve to the brachialis branch of the musculocutaneous nerve. The immediate postoperative course was stable with preserved donor motor function. Follow-up is not yet available. This case describes the attempted restoration of elbow flexion in a suspected non-recovering PTS using a double fascicular transfer. Because long-term functional outcome data are pending, the report emphasizes diagnostic uncertainty, careful documentation of failed recovery, preservation of donor function, and the need to balance continued observation against the risk of delayed reinnervation.