Symptomatic Neurological Thoracic Outlet Syndrome
Pathology
- Usually not related to bony or soft tissue anomalies
- Intermittent compression of neurovascular structures as a result of repetitive postural, occupational, or physical activity forces that create temporary compression at a variety of locations in the cervical and thoracic outlet
Signs and Symptoms
- Common history of neck trauma preceding symptoms usually from car accidents and repetitive stress at work
- Mainly neurological, intermittent, and transient
- Distal symptoms of pain, aching, “spasm”, tingling, tightness, and/or numbness
- Feelings of weakness and fatigue in hand or upper extremity (especially during overhead movements)
- Tenderness, swelling or loss of upper extremity motor control
- Pain in forearm, hands, and wrist
- Possible pain in the lower neck, shoulder, elbow, upper back, pectoral region, lateral humerus, and suprascapular and medial scapular regions
- Possible cervical pain and headaches
- Pain is aggravated by repeated overhead movements and shoulder depression
- Pain at rest
- Pain, paresthesia, numbness, and/or weakness in the hand, arm (C8/T1 distribution), shoulder, and neck
- Occipital headaches
- Paresthesias and numbness at night, patient awakening due to pain/numbness
- Loss of dexterity
- Cold intolerance
- Raynaud phenomenon, hand coldness, color changes due increase sympathetic nervous system activation
- Releasers: symptoms at night more than during the day
- Disputed neurogenic: subjective weakness and/or sensory deficits
(Hooper et. al., 2010; Huang & Zager, 2004; Watson et. al., 2009)