PURPOSE: This study sought to determine the incidence of Neuralgic Amyotrophy (NA) in the United States of America's health system, most common presenting symptoms, time from symptom onset and time from initial presentation to diagnosis, number and specialty of clinicians seen prior to diagnosis, and specialty of diagnosing clinician. METHODS: A retrospective chart review study was conducted to identify all patients diagnosed with ICD-10 G54.5 from September 1, 2016 - December 31, 2023. RESULTS: 153 patients with NA diagnoses from 2016-2023 were included. The average incidence of NA in the United States of America's healthcare system was 1.77/100,000 per year. The most common chief concern upon presentation was shoulder pain, (n = 57, 37.2%) and the most common secondary or tertiary concern was shoulder weakness (n = 41, 26.7%). Average time from symptom onset to diagnosis was 101.3 days (SD = 155.4; median = 51 days), and from initial presentation to diagnosis was 78.1 days (SD = 145.6; median = 28 days). Sixty-three patients (41.2%) presented to one other clinician with similar symptoms prior to diagnosis, 37 (24.2%) saw two clinicians, 16 (10.5%) saw three, and 7 (4.6%) saw four or more clinicians. Patients most often initially presented to a family medicine, primary care, or urgent care clinician (n = 61, 39.9%). The most common specialties of diagnosing clinicians were orthopaedic surgery (100 diagnoses, 65.4%), neurology (23 diagnoses, 15%) and neurosurgery (15 diagnoses, 10%). CONCLUSION: Diagnosis of neuralgic amyotrophy is historically rare, but the incidence may be higher than previously thought. Neuralgic amyotrophy is a debilitating disorder that is often initially unrecognized, ultimately leading to a months-long delay in diagnosis. Over 80% of patients were seen by at least one other clinician before diagnosis, and orthopaedic clinicians were most likely to make the diagnosis. CLINICAL RELEVANCE: Maintaining a high clinical suspicion while recognizing the common presenting symptoms along with onset and evolution of symptoms would help facilitate timely referral to specialists trained in identifying and managing neuralgic amyotrophy, prevent unnecessary and unproductive appointments preceding the diagnosis, and allow earlier initiation of treatment. LEVEL OF EVIDENCE: Diagnostic Type IV.
Wallace et al. (Sun,) studied this question.