The trouble with neuralgic amyotrophy

Imagine yourself waking up early one morning with a severe pain in your shoulder and upper arm. At first you attribute this to some strain a day or so before, but after a few hours the pain has become so severe that you go to your family practitioner or emergency department in a slight panic. The doctor looks at your shoulder and arm but sees nothing amiss, apart from the fact that you are constantly holding your arm close to your body, keeping it immobile. You are reassured that nothing appears to be seriously wrong, given a non-steroidal anti-inflammatory drug (NSAID), and sent home with advice to see a physical therapist. After a few sleepless weeks because of the relentless pain, and several unsuccesful therapeutic sessions, the therapist notices that your scapula seems to be protruding and the whole shoulder looks as if it has sagged. Some muscles are atrophic too. You are therefore referred to a neurologist or orthopaedic surgeon because of suspected radicular or shoulder joint pathology. Hopefully there will not be too much delay spent on a waiting list, and if you’re lucky you will be one of the 40% where the consulting specialist recognises the clinical picture. The chances are however that you will have to wait again for a radiological study of the cervical spine or shoulder region, and because this usually is normal you are either sent back to your family doctor or physical therapist, or referred for a second opinion, still without a proper explanation for your symptoms. Eventually–but this may often be more than six months later—someone thinks of a peculiar neurological disorder called neuralgic amyotrophy, and you find yourself discharged from further specialist care with the message that nothing can be done and spontaneous recovery will follow in a few years—which …