Case: 32 year old female presented with acute left sided shoulder pain and swelling. Hint: see picture below?
Answer: Thoracic Outlet Syndrome (TOS)
In general, TOS occurs in young people. There are 3 kinds of TOS
Neurogenic TOS (80%): an injury probably causes tearing and spasm in the scalene muscles, which become inflamed and scarred, irritating the adjacent nerves.
Arterial TOS (5%): the patient has developed an aneurysm of the subclavian artery in the neck; clots may break off and travel to the hand, which turns painful and numb.
Venous TOS (15%) — sometimes called “effort thrombosis” — begins when the subclavian vein is pinched between the rib and collarbone, which leads to a vein injury. With repeated injuries, a cuff of scar tissue forms, narrowing the vein; pressure builds up behind it, and the body forms collateral vessels to handle the blood flow. But the obstructed vein still has some stagnant blood flow, prone to forming a clot; if this clot propagates, blocking the collaterals, the arm suddenly swells.
Surgery is mostly required.
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