Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of neurogenic thoracic outlet syndrome, including paresthesia, numbness, and aching pain localized to the neck, shoulder, and medial aspect of the arm/hand (C8-T1 distribution). Symptoms are exacerbated by overhead activities, repetitive reaching, or prolonged static postures. No history of acute trauma. Denies significant vascular symptoms such as coldness, cyanosis, or edema.
Clinical Examination Findings
Physical examination reveals tenderness over the supraclavicular fossa and scalene triangle. Positive provocative testing noted: Roos test (EAST) positive for reproduction of symptoms within 3 minutes; Adsonβs maneuver positive for diminished radial pulse and symptom reproduction. Neurological exam shows mild sensory deficit in the ulnar nerve distribution; motor strength 5/5 in intrinsic hand muscles, though fatigability is reported. No atrophy of the thenar or hypothenar eminences.
Treatment Protocol
Conservative management initiated: Referral to physical therapy for scapular stabilization, postural correction, and scalene muscle stretching. Activity modification advised to avoid overhead lifting and repetitive strain. Pharmacological management includes NSAIDs for pain control and muscle relaxants as needed. Follow-up scheduled in 6 weeks to assess functional improvement.