Differential Diagnosis of Thoracic Outlet Syndrome
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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
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