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)
