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454 - Pinched Nerves and Burning Pain: A Case Study of Thoracic Outlet Syndrome Confirmed by EMG

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

AM

Armaghan M. Mardashti, MSc

Medical Student, OMS 4
Noorda College of Osteopathic Medicine
Sugar land, Texas, United States

Co-Author(s)

SS

Syed A. Shah, n/a

Medical Student
PCOM South Georgia
Cumming, Georgia, United States

Corresponding Author(s)

OS

Omar Selod, DO

physician
PMR Fort Worth
Fort Worth, Texas, United States

Case Diagnosis: Thoracic Outlet Syndrome

Case Description: The patient presents with a 4-month history of bilateral numbness and tingling in the fourth and fifth digits, worse on the left side, along with left-arm burning pain radiating from the axilla to the hand. She reports occasional left shoulder pain, neck stiffness, and worsening symptoms with prolonged sitting or standing. The patient also reports recent gait instability. Physical therapy provided minimal relief. MRI of the cervical spine revealed moderate left foraminal narrowing at C6-C7, with no significant stenosis, while a brain MRI was unremarkable. Physical exam showed diminished sensation in the left fourth and fifth digits, positive Tinel’s at the left elbow, and positive Adson, Wright, and Neer tests on the left side. Electrodiagnostic studies indicated left-sided lower trunk brachial plexopathy, suggestive of thoracic outlet syndrome, and mild right-sided ulnar neuropathy at Guyon’s canal. No evidence of cervical radiculopathy or peripheral neuropathy was noted.

Discussions: In this patient, the symptoms of numbness, tingling, and burning pain in the distribution of the ulnar nerve (fourth and fifth digits) indicate neurogenic TOS. The left-sided dominance of symptoms, in conjunction with left foraminal narrowing at C6-C7 seen on MRI, further supports the diagnosis. Prolonged sitting and standing exacerbating the symptoms is also consistent with TOS, as these positions can increase pressure on the thoracic outlet.

Conclusions: Thoracic outlet syndrome requires a multifaceted diagnostic and therapeutic approach tailored to the patient's etiology and symptomatology. This patient's treatment plan includes an initial appointment with a specialist for further evaluation and consideration of physical therapy, medications, and possibly surgical options. Future studies could explore the impact of workplace ergonomic interventions on TOS outcomes, as well as the role of insurance in accessing necessary treatments.