A 27-yrs-old woman seeks your advice regarding pain and numbness in the right arm and hand .. She reports that it is exacerbated by raising her arm over her head. A provisional diagnosis is made. Which statement is true of this conditions?
The thoracic outlet syndrome designates a symptom complex whose precise cause is unknown. It is felt to result from compression of the brachial plexus or subclavian vessels, or both, in the anatomic space bounded by the first rib, the clavicle, and the scalene muscles. Since objective determinants of disease may be lacking or imprecise, the diagnosis often is established by resectional surgery. Carpal tunnel syndrome (compression of the median nerve as it passes through the carpal tunnel of the wrist) and cervical disk disease are the two entities most commonly confused with the thoracic out let syndrome, whose symptoms and signs include pain, paresthesias, edema, venous congestion, and digital vasospastic changes. Positional dampening or obliteration of the radial pulse is an unreliable finding since it is present in up to 70% of the normal population. Neurologic abnormalities may be documented by nerve conduction studies. Angiographic studies are often negative. Conservative management, which generally should precede surgery, consists of an exercise program to strengthen shoulder girdle muscles and decrease shoulder droop. Operative treatment includes division of the scalenus anticus and medius muscles, first rib resection, cervical rib resection, or a combination of all three.
It is associated with cervical spine disk disease
It is reliably diagnosed by positional obliteration of the radial pulse
If conservative measures fail, it is best treated by surgical decompression of the brachial plexus
It most commonly affects the median nerve