Could it be Thoracic Outlet Syndrome?

by Amber
(Appleton, WI, USA)


I've been experiencing shoulder and neck pain for months. I've seen my PCP and a Physiatrist, which have resulted in Physical Therapy for Rotator Cuff dysfunction. No imaging has been done. The onset of pain was sudden, as in overnight.

I also have a small, what appears to be nerve, going over my collarbone which sends "zings" down my left arm if touched. My arms feel weak and tire easily. Could this be Thoracic Outlet Syndrome? Thanks for any insight, I appreciate it. It's been an uphill battle trying to find anyone who cares.

Hello Amber,
Do a few little tests for me, giving accurate answers to each if you want a useful reply.

1. Move your arm and shoulder in all ranges of motion; are any limited or painful? Which, and where does it hurt?

2. With your bent elbow at your side, grasp your wrist with your right hand; with no shoulder movement, push inwards against your right hand, and then pull out. Do either hurt?

3. With your arm in front of you, thumb pointing down, lift your arm above your head; does it hurt? Where?

4. Is doing your bra behind your back difficult?

5. Does turning your head to the left, and simultaneously looking up cause neck or arm pain?

Now, using the Site Search function at Chiropractic Help, look up the 'arm pain quick dash' questionaire. Print it out, do it, and keep a record of it for future reference. What score do you get?

To my knowledge there are no nerves traveling over the collarbone; certainly none of the large and significant ones. I'm wondering if it could be something to do with the bone itself, or one of the joints at either end; are they also tender?

I somehow don't think this is thoracic outlet syndrome, but obviously I can't be sure, being unable to examine you. The classic test is difficult, but you could try it. Using your right index and middle finger find a strong pulse in your left wrist. Now turn your head to the left, look up, and take in a deep breath; does it significantly affect the strength of the pulse? Does it return when you breathe out and return your head to normal?

A lot of homework for you! Accurate answers if you want anything useful from this conversation.

Dr b

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