Thoracic Outlet Syndrome

Thoracic outlet syndrome is a condition where the nerves to the arm, the brachial plexus, are squashed between the collar bone (clavicle) and the first rib beneath. When the patient repetitively raises their arms up (as in hanging sheetrock on the ceiling) they can have numbness and nerve difficulties with their arms. However, these symptoms do not necessarily indicate that an operation is needed.

They can be instructed to change their job, and physical therapy can be effective. If the condition is severe it must be confirmed by doing what is called an Adson maneuver. This involves raising your arm up in the air and all the way back to where the pulse to your wrist is cut off.

The artery goes through the same area the nerves are going through, and will be compressed by the squeezing action of those two bones. If this test is positive it does not necessarily mean that surgery is needed; many people can have a positive test without any symptoms.

Neurologically the area is evaluated with electrical studies, such as an electromyogram and nerve conduction studies, and, if you document an area of damage, then the arteriogram x-ray should also be done.

After all conservative therapy fails and the cause is documented, the operation can be performed. It's done through the axilla (the armpit region) and there is a risk of nerve injury. The risk depends upon who is operating. The risk of causing nerve damage to that brachial plexus from carelessness can be from five to fifty percent. That's one issue of negligence, as well as any departures from the standards of care, if proper informed consent was not obtained, if physical therapy to avoid surgery was not done, alternatives were not discussed, and unnecessary surgery was performed.

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