Symptoms of Neurogenic-Arterial Thoracic Outlet Syndrome

Abstract

Commonly the symptoms associated with neurogenic compression are pain, paresthesias, numbness, tingling, and, occasionally, weakness of the hand muscles of the involved arm. Less frequently, associated arterial compression may produce paleness of the arm particularly when it is elevated to 90° or 180° of abduction [1–11]. These symptoms may be present for months or sometimes even years without producing any complications. As the symptoms progress, however, the entire hand and sometimes part of the forearm may become involved. Over 85 % of patients with advanced disease complain of pain, numbness, and tingling of the hand and fingers [8, 9, 12–14]. All of them, however, will complain of a throbbing type of pain involving the entire arm, including the forearm and the hand, when the arm is abducted 90° to the shoulder level, or above that level (i.e., when they try to reach over their heads). Many times the patients cannot raise the arm over their head because of the tightening and pain experienced not only around the forearm but also around the shoulder, extending on occasion to the back at the base of the neck. As the symptoms become more severe patients may have difficulty driving their vehicles because they are unable to maintain their arms on the steering wheel preferring to keep them in their laps. Discomfort of this severity is present in 100 % of cases and causes most patients to seek medical attention. The patients who suffer concomitantly from subclavian artery compression demonstrate immediate paleness of the hand upon elevation of the arm over their heads which rapidly returns to normal as it is lowered.