[Neuralgic shoulder amyotrophy]

The syndrome of neuralgic myatrophy of the shoulder usually presents with a classical clinical picture: sudden onset of intense pain in the shoulder and/or upper arm, followed after hours, days or weeks by (often myatrophic) paresis of the muscles of the shoulder region. Palsy and muscle atrophy reach their maximum within 4 weeks. On the basis of this typical sequence, the diagnosis was established in 22 patients during the period from 1983 to 1994. In agreement with previous observations, males represented double the number of female patients. The mean age at onset of the syndrome was 52.6 years (range 16-81 years). Possible triggering factors were registered in 11/12 patients: infections, abnormal physical activity or operative procedures 1-3 weeks ahead of the first symptoms. No preferential lateralization was noted. Most frequently paresis occurred in the deltoid and--in descending order--in the infraspinatus, supraspinatus and biceps muscles. Scapula alata was observed 7 times in 5 patients and concomitant unilateral paresis of the diaphragm in 3 cases. In 5/22 patients NSA was bilateral, simultaneous or successive, usually asymmetrical and severe. Symptoms of sensory deficit were rare and usually resolved rapidly. Electromyographic examination was essential for diagnosis, pointing to localization, follow-up and prognosis. Follow-up information was obtained in a majority of patients and in 17/20 cases showed a favourable course with complete recovery.