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Case report

Arm numbness at 45 degrees abduction: A case report of thoracic outlet syndrome post brachial neuritis

Jamie L. Fleet, Srinivasan Harish, James Bain, Steven K. Baker
Physical Medicine and Rehabilitation, McMaster University, , Hamilton, Canada
DOI: 10.2340/20030711-1000034

Abstract

Objective: To describe a case of nerve kinking correlating with surgical findings in neurogenic thoracic outlet syndrome in a patient with history of brachial neuritis. Thoracic outlet syndrome and brachial neuritis are briefly reviewed.
Case report: A 32-year-old woman with a history of bilateral brachial neuritis presented with paraesthesias in her hand when abducting her shoulder to 45° or higher. A kink in the superior trunk of the brachial plexus, as well as asymmetrically narrowed costoclavicular space, was found on magnetic resonance imaging with the shoulder abducted. Conservative measures failed, leading to partial anterior scalenectomy and neurolysis, which led to improvement in her symptoms.
Conclusion: Anatomical variations in combination with biomechanical changes after brachial neuritis can be associated with neurogenic thoracic outlet syndrome.

Lay Abstract

Brachial neuritis is a painful condition of a group of nerves in the arm and shoulder, which often occurs spontaneously. This is associated with weakness. A different condition, thoracic outlet syndrome, can also cause problems with the nerves or blood vessels in the arm, due to squeezing on these structures, for a variety of reasons. Our case is of a woman initially presenting with brachial neuritis, who then developed thoracic outlet syndrome during her physiotherapy. The weakness she developed from the brachial neuritis led to abnormal movements of her shoulder, causing the nerves in her arm to be squeezed, and her hand to become numb. She underwent magnetic resonance imaging, showing the nerve was kinked in this area. She eventually had surgery to release the kink, which almost completely resolved her symptoms.

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