Thoracic Outlet Syndrome: The Daily PANCE Blueprint

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Thoracic Outlet Syndrome: The Daily PANCE Blueprint

A 35-year-old female presents with intermittent right arm pain, numbness, and tingling. It worsens when she lifts objects overhead. She denies swelling or color changes. On exam, there is mild weakness of the right hand grip. Radial pulse remains palpable. Which of the following best explains the underlying mechanism of her symptoms?

A. Compression of the subclavian vein between the clavicle and first rib
B. Compression of the subclavian artery leading to distal ischemia
C. Entrapment of the median nerve within the carpal tunnel
D. Compression of the brachial plexus within the thoracic outlet
E. Compression of the ulnar nerve at the cubital tunnel

Answer and topic summary

The answer is D. Compression of the brachial plexus within the thoracic outlet

Thoracic outlet syndrome (TOS) refers to a constellation of signs and symptoms resulting from compression of the neurovascular bundle in the thoracic outlet. Causes include trauma, repetitive injuries, anatomical defects, and pregnancy. The clinical presentation depends on the structure being compressed (i.e., nerve, vein, or artery), but may include the following: pain, numbness, weakness, fatigue, swelling, or coldness. Often these symptoms are aggravated by activity or raising the arm overhead. Diagnostic tests include ultrasound, x-ray, CT scan, EMG, MRI, etc. Treatment options depend on what type of TOS the patient has (e.g., physical therapy for neurogenic TOS).

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Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Spinal Disorders ⇒ Thoracic outlet syndrome

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