True Neurological Thoracic Outlet Syndrome

Pathology

• Irritation, compression, or traction of the brachial plexus creating compromised nerve function
  
• Compression occurs from a bony or soft tissue congenital anomaly
  
• Compression is caused by repetitive or significant trauma and is influenced by postural, occupational, or physical activity factors

Signs and Symptoms

• Common history of neck trauma preceding symptoms usually from car accidents and repetitive stress at work
  
• Gilliatt-Summer hand (“Scalloped” appearance of thenar eminence)
  
• Severe thenar wasting, mainly abductor pollicis brevis
  
• Less involvement of interossei and hypothenar muscles
  
• Upper Plexus Syndrome (C5/C6/C7 Pattern)
  
• Sensory changes in first three fingers
  
• Possible numbness in cheek ,earlobe, back of shoulder, or lateral arm
  
• Weakness in deltoid, biceps, triceps, scapular muscles, and forearm extensors
  
• Pain in anterior neck, chest, supraclavicular area, triceps, deltoids, parascapular muscles, and forearm extensors
  
• Possible pain in the neck, pectoral area, face, mandible, and ears
  
• Possible dizziness, vertigo, and blurred vision
  
• Lower Plexus Syndrome (C7/C8/T1 Pattern)
  
• Sensory changes in the fourth and fifth fingers and above medial elbow
  
• Pain and paresthesia in medial arm, forearm, and ulnar 1 ½ digits
  
• Hand weakness, loss of dexterity, and wasting of hand intrinsics
  
• Pain, paresthesia, numbness, and/or weakness in the hand, arm (C8/T1 distribution), shoulder, and neck
  
• Occipital headaches
  
• Paresthesias and numbness during the day and patient awakening due to pain/numbness
  
• Loss of dexterity
  
• Cold intolerance
  
• Raynaud phenomenon, hand coldness, color changes due increase sympathetic nervous system activation
  
• Compressors: symptoms  during the day more than at night
• True neurogenic: objective weakness and/or sensory deficits

(Hooper et. al., 2010; Huang & Zager, 2004; Watson et. al., 2009) 

References