Thoracic outlet syndrome



Thoracic outlet syndrome

Musculoskeletal system


Thoracic outlet syndrome


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USMLE® Step 1 questions

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Thoracic outlet syndrome

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USMLE® Step 1 style questions USMLE

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A 23-year-old man comes to his primary care physician to evaluate the sudden onset of numbness and tingling in the right upper extremity following a workout. The patient was performing sit-ups when he experienced a sharp pain in his neck, followed by numbness and tingling in his right hand. He does not have any symptoms while at rest. He reports several similar episodes in the past. He is a bodybuilder. Vital signs are within normal limits. The right lateral neck appears larger when compared to the left lateral neck. The patient has no spinal tenderness to palpation. Which of the following is the most likely underlying cause of this patient’s symptoms?  

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Pancoast tumor p. 710

thoracic outlet syndrome p. 456


Thoracic outlet syndrome (TOS) involves compression at the thoracic inlet, which is known clinically as the superior thoracic outlet, resulting from excess pressure placed on the neurovascular bundle passing between the anterior scalene and middle scalene muscles.

TOS can affect one or more of the nerves that innervate the upper limb and/or blood vessels as they pass between the chest and upper extremity, specifically in the brachial plexus, the subclavian artery, and rarely, the subclavian vein. TOS can be caused by a variety of factors, including repetitive arm and shoulder movements, trauma, or anatomical abnormalities.

Symptoms of TOS may include pain, weakness, numbness, and tingling in the arms and hands, especially when performing overhead activities or carrying heavy objects. Treatment for TOS depends on the underlying cause and severity of the condition, and may include medications like corticosteroids, or even surgery.


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