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730 - Unveiling Neurogenic Thoracic Outlet Syndrome: A Case of Cervical Ribs and Post-Operative Complications

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

BM

Bhargavi Madhu, DO

resident, pgy2
Larkin Community hospital South
doral, Florida, United States

Co-Author(s)

MC

Maria Cecilia Guerrero, dO

Resident, PGY II
Larkin Community Hospital South
Miami, Florida, United States

Presenting Author(s)

DP

De’Jon Parker, DO

Resident, PGY II
Larkin Community Hospital South
miami, Florida, United States

Co-Author(s)

Hein Linn Thant, MD

PGY III PM&R Resident
Larkin Community Hospital
West Palm Beach, Florida, United States
PS

Puja Shah, DO

Resident, PGY-II
Larkin Community Hospital
Miami, Florida, United States
SS

Sahil S. Shah, DO

Resident Physician
Larkin Community Hospital
Miami Lakes, Florida, United States

Case Diagnosis: A 29-year-old female with a history of autism, PCOS, scoliosis, and Chiari malformation (post-decompression surgery) was diagnosed with neurogenic thoracic outlet syndrome (TOS), attributed to bilateral cervical ribs and prior cervical surgery.

Case Description: The patient initially experienced gradual bilateral forearm and hand pain, numbness, tingling, and weakness 4 months into participating in physical therapies after a cervical decompression surgery, despite initial improvement in functional performance. The worsening symptoms were initially thought to be postoperative complications, but were later identified as neurogenic TOS after imaging revealed the presence of bilateral cervical ribs. She was referred to a vascular surgeon who recommended and performed bilateral cervical rib resection. Six months post-surgery, the patient demonstrated gradual recovery in bilateral arm strength and complete resolution of symptoms.

Discussions: Neurogenic TOS poses diagnostic challenges due to its variable presentation and reliance on exclusion criteria. Congenital cervical ribs may be asymptomatic for years but can precipitate TOS following trauma or surgery. In this case, cervical decompression likely intensified compression of local neurovascular structures, worsening the patient's symptoms. Conservative treatments, including physical therapy, were inadequate, demonstrating the necessity of surgical intervention in refractory cases.

Conclusions: This case highlights the importance of early diagnosis, and targeted treatment for neurogenic TOS. When conservative measures fail, as seen in this patient, surgical rib resection can significantly alleviate pain and improve upper extremity function in appropriate cases. Prompt recognition and intervention are crucial for managing TOS and preventing progressive functional decline.