Neurogenic Thoracic Outlet Syndrome

Abstract

A 30-year-old woman presented with complaints of pain in her neck, right shoulder, right trapezius, right anterior chest wall, right arm, elbow and forearm; occipital headaches every other day; numbness and tingling in all fingers of the right hand, but worst in the fourth and fifth fingers; aggravation of her symptoms when elevating her arms, especially to comb or dry her hair or drive a car; weakness of her right hand and dropping coffee cups; and coldness and colour changes in her right hand. The symptoms had been present for 1 year and began following a rear-end car collision when she was waiting at a traffic light. She was wearing a seatbelt and recalled going forwards and backwards, but she did not recall what happened to her neck at the time of the accident. She had no immediate symptoms. The next day, she awoke with a sore neck and pain above her shoulder blades. A few days later, she began noticing headaches in the back of her head that radiated forward to behind her eyes; the neck soreness became progressively painful. Two or three weeks later, pain developed in the right shoulder area and down the right arm. Several weeks later, numbness and tingling developed in the fingers of the right hand, most noticeably in the ring and little fingers. Because of severe, persistent right shoulder pain, arthroscopic repair of the right shoulder had been performed 6 months ago, with partial improvement of the shoulder pain but no change in any of the other symptoms.