Posttraumatic Neurogenic Thoracic Outlet Syndrome and Immediate Effects of Decompressive Surgery: A Case Report.

Abstract

Neurogenic thoracic outlet syndrome (TOS) results from a combination of trauma and congenital anatomical predisposition. Although trauma is recognized as a significant contributor to neurogenic TOS, it is predominantly linked to injuries such as whiplash-type neck injuries in individuals with predisposing congenital anatomical structures. Reports on neurogenic TOS resulting from major trauma, including fractures and dislocations near the brachial plexus pathway, are rare. We report a rare case of a patient with persistent paralysis in the right shoulder, preventing abduction, extension, and elbow flexion following a contusion and soft tissue trauma to the right side of the neck. The initial diagnosis of post-traumatic neurogenic TOS following soft tissue trauma was missed until magnetic resonance imaging was conducted 8 months after injury, which revealed unexplained paralysis in the right upper extremity. Decompression of the right brachial plexus with scalenectomy resulted in immediate alleviation of paralysis of the shoulder and elbow. The diagnosis of post-traumatic neurogenic TOS should be considered when a patient who has sustained significant neck trauma presents with symptoms of weakness, heaviness, numbness, and tingling paresthesia in the ipsilateral upper extremity, and these symptoms are not attributable to cervical spine pathology.