The thumb test
“May I examine you?” asked the neurologist. The young man agreed, and the doctor began to test his upper body strength – first on the normal right side, then on the left side. The strength was the same on both shoulders, which raised the arm and pressed it down. The strength in the biceps was also the same: she straightened up and bent at the elbows. Then Sivak took the man’s right hand as if shaking hands. Turn inward, he directed the patient. Now outward. Normal. He did the same on the left. Significantly much weaker. Then he let the young man bend his thumb at the last joint. He pushed down on the nail and instructed the man to extend his thumb. It was just on the right. But impossible on the left. “I think I know what’s going on,” Sivak said finally.
The young man had what is known as Parsonage-Turner syndrome, an inflammation of the nerves of the brachial plexus, the neurologist reported. The brachial plexus is the segment of nerve fibers that connect the spinal cord to the peripheral nerves in the shoulder and arm, the neurologist explained. It starts with pain – usually severe pain – and leads to weakness and muscle wasting. Left alone it usually resolves, but the process can take years. However, the doctor added that some research suggests that five days of high-dose steroid treatment may speed healing early. He had previously looked after patients with the disease and often saw improvement after a single dose of the drug. He recommended starting the steroids as soon as possible.
Parsonage-Turner syndrome, also known as acute brachial neuritis, was first described by a doctor in Germany more than a century ago. It is named after two British neurologists, Maurice Parsonage and John Turner, who published a description of 136 cases of the disorder in 1948. In these cases, pain and weakness occurred days to weeks after trauma, usually infection or surgery. In the decades since, the syndrome has usually been described as rare, but a study published a few years ago found it to be far more common than previously thought – only often overlooked.
Strengthen and straighten
The patient reluctantly consented to treatment. He usually didn’t take any medication and didn’t want to take any, but the idea of years of pain was even less attractive. When the patient received the second infusion, Sivak came to see him. How did he feel? A little better? Stronger? The athlete shook his head. No change. The neurologist took the young man’s hands and tried the strength of his two thumbs again. On the left, where the patient was unable to move due to the doctor’s pressure, he was now able to straighten the joint. It still wasn’t as strong as the right thumb, but it was better.
As soon as he finished the steroids, he began physical therapy again. Slowly his arm and shoulder became more supple and regained their former strength. I spoke to the patient three months after his treatment and he told me that 90 percent of the time he was there. A few months later he reported that he had returned to his old strength, his old self.
I spoke to the patient again recently. His shoulder and arm are fine. He’s still doing the stretches he was taught to do in physical therapy two years ago, and feels like the pain and weakness will creep back when he stops. But he’s back in the gym, lifting weights with no problems. He hasn’t tried another marathon. He wonders if he somehow trained the wrong way and injured his nerves in the process. He loved running this marathon, but he didn’t love it back. These days he started cycling. And he says it’s almost as good.