Thoracic Outlet Syndrome and Stingers

Question 1

A neurovascular compressive neuropathy with either a neurogenic or vascular etiology.

Neurogenic:
- caused by compression of neurovascular bundle as it passes over the first rib through the scalene muscle.

Vascular: caused by compressed subclavian vessel or aneurysm and may lead to emboli in the hands.

Answer 1

Thoracic Outlet Syndrome

Question 2

Thoracic Outlet Syndrome Symptoms

Answer 2

Upper Extremity Pain + Numbness
Gradual Onset
Pain Radiates from Point of Compression

Paresthesias over Volar aspect of 4th + 5th Fingers

Symptoms can be provoked by having the patient put their arms in “STICK EM UP” position

“I got robbed at the Outlet Mall”

Question 3

Imaging for Thoracic Outlet Syndrome

Answer 3

X-Ray
- rule out Cervical Rib
- rule out Pancoast Tumor

Angiography
- subclavian vessel disease or aneurysm

Question 4

Thoracic Outlet Syndrome Treatments

Answer 4

Non-operative:
- PT → 1st line

Operative:
- neurologic decompression
- vascular reconstruction

Question 5

Transient brachial plexus neuropraxia. Common in collision sports such as football.

1 episode increases risk of another by 3x

“Dead Arm Syndrome”
“Brachial Plexopathy”

Answer 5

Stingers

Question 6

Stinger Symptoms

Answer 6

Unilateral tingling in arm
- not typically isolated to a single dermatome

Usually resolves in 1-2 minutes

Unilateral Weakness in C5 and C6 Muscles
- biceps + deltoid

(+) Spurling Test

Question 7

When should an MRI be obtained with a Stinger?

Answer 7

Bilateral Symptoms
- rule out cervical spine pathology

Question 8

When should an EMG be obtained with a Stinger?

Answer 8

Symptoms persist after 3 weeks

Question 9

Stinger Treatment

Answer 9

Non-Operative

Player may return to Play if:
- complete resolution of symptoms