Best Practice Case Studies-Neurology

Pdf Summary

The document presents a case study regarding a 39-year-old female recreational swimmer experiencing symptoms indicative of neurogenic thoracic outlet syndrome (TOS) and a study question about another patient with potential vascular TOS. The 39-year-old athlete exhibits symptoms primarily affecting the fourth and fifth digits of the hand, consistent with TOS involving the lower trunk of the brachial plexus. Symptoms are associated with repetitive overhead activities, and there's no evidence of vascular compromise present. Neck, shoulder, or supraclavicular pain can sometimes accompany TOS but might be vague. <br /><br />The document confirms that the correct answer for the study question is A, indicating symptoms in the fourth and fifth digits.<br /><br />For a second scenario concerning an 18-year-old male baseball pitcher, the symptoms suggest possible subclavian artery compression. The Roos stress test is indicated as the appropriate maneuver to recreate symptoms for diagnosing subclavian artery compression. The Roos test is performed with specific arm positions, checking for a sensation of heaviness or symptom reproduction. It's noted that the Tinel’s test, Spurling’s maneuver, and the inability to form a finger-thumb circle are related to other conditions, not subclavian artery compression. <br /><br />The document highlights important differentiation within thoracic outlet syndrome, noting neurologic versus vascular components. Neurologic TOS involves brachial plexus compression, while vascular TOS involves subclavian vessel compression. The space defined by the thoracic outlet is vital for understanding compression-related symptoms.<br /><br />In summary, the document presents two cases indicating different aspects of thoracic outlet syndrome, explaining symptomatic relevance, distinguishing between neurologic and vascular components, and discussing pertinent provocative tests for accurate diagnosis.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 38

Topic Neurology

Keywords

neurogenic thoracic outlet syndrome

vascular thoracic outlet syndrome

brachial plexus

subclavian artery compression

Roos test

repetitive overhead activities

fourth and fifth digits

symptom differentiation

provocative tests

case study

3rd Edition

3rd Edition, CASE 38

Neurology