Ann Rehabil Med.  2011 Aug;35(4):565-569. 10.5535/arm.2011.35.4.565.

True Neurogenic Thoracic Outlet Syndrome Following Hyperabduction during Sleep: A Case Report

• Lee JH
• Choi HS
• Yang SN
• Cho WM
• Lee SH
• Chung HH
• Shin JS
• Kim DH

• KMID: 1971724
• DOI: http://doi.org/10.5535/arm.2011.35.4.565

Abstract

True neurogenic thoracic outlet syndrome (TOS) is an uncommon disease and is difficult to diagnose at the early stage and then completely cure. We experienced a case of true neurogenic TOS with typical clinical symptoms and electrophysiologic findings as a result of repetitive habitual sleep posture. A 31-year-old woman who had complained of progressive tingling sensation on the 4th and 5th fingers with shoulder pain was diagnosed of brachial plexopathy at the lower trunk level by electrodiagnostic studies. There was no other cause of brachial plexopathy except her habit of hyperabduction of shoulder during sleep. This case demonstrated that the habitual abnormal posture can be the only major cause of neurogenic TOS. It is of importance to consider TOS with the habitual cause because simple correction of the posture could stabilize or even reverse disease progress.

Keyword

Thoracic outlet syndrome; Neurogenic; Hyperabduction sleep

MeSH Terms

Adult
Brachial Plexus Neuropathies
Female
Fingers
Humans
Posture
Sensation
Shoulder
Shoulder Pain
Thoracic Outlet Syndrome

Figure

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  Fig. 1 (A) The right hand thenar muscle was atrophied (arrow). (B) Sensation on the medial side of the arm and forearm and little finger (medial to the dot line) was decreased.

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  Fig. 2 (A) The right median motor response was of low amplitude. (B) The right ulnar motor response was normal. (C) The right median sensory response was normal. (D) The right ulnar sensory response was of low amplitude.

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  Fig. 3 Arteriogram demonstrated no compression of subclavian artery during shoulder abduction (A, B), but venogram showed compression of the right subcalvian vein around the thoracic out during shoulder abduction (arrow) (C, D).

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