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Suggest Treatment For Thoracic Outlet Syndrome
Question: My husband has shoulder pain affecting his left arm, going down into hand. With extended use, he's a mechanic, his arm occasionally goes numb. He sometimes feels a pop or a crack in the shoulder clavicle area. He is waiting to be seen by primary. Was seen at urgent care. Diagnosed with thoracic outlet syndrome. No xray or MRI. Not getting much relief with prescriptions. Thoughts?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Thoracic outlet syndrome could well justify those symptoms you describe. The most common issue to be differentiated with is a neck problem such as a disc herniation in the cervical spine with nerve root compression. Usually they are differentiated by the distribution of the pain, sensory changes, certain maneuvers done to reproduce symptoms during physical exam, I hope they've been done in the ER to reach that diagnosis. In typical cases a MRI is not necessary. In most cases x-rays, MRIs result normal. However usually since it is a cheap test an X-ray is performed to check for bone abnormalities (like an abnormal first rib). When in doubt a MRI may be done as well, but only when in doubt to exclude other issues, it doesn't diagnose thoracic outlet syndrome. Nerve conduction studies is another test which may be done when in doubt, but it is a supportive test, it is of value when abnormal, but if normal doesn't exclude the diagnosis. So to resume in terms of tests a Xray should be done, while MRI and nerve conduction studies only if physical exam is doubtful.
As for treatment in terms of medication apart from analgesics like Ibuprofen there are not many other options. The mainstay of management is rather physical therapy. So if your primary believes that to be the diagnosis as well, he should prescribe physical therapy sessions. If that is not effective then surgery may be considered. In most patients that is not necessary though as physical therapy leads to improvement.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Thoracic outlet syndrome could well justify those symptoms you describe. The most common issue to be differentiated with is a neck problem such as a disc herniation in the cervical spine with nerve root compression. Usually they are differentiated by the distribution of the pain, sensory changes, certain maneuvers done to reproduce symptoms during physical exam, I hope they've been done in the ER to reach that diagnosis. In typical cases a MRI is not necessary. In most cases x-rays, MRIs result normal. However usually since it is a cheap test an X-ray is performed to check for bone abnormalities (like an abnormal first rib). When in doubt a MRI may be done as well, but only when in doubt to exclude other issues, it doesn't diagnose thoracic outlet syndrome. Nerve conduction studies is another test which may be done when in doubt, but it is a supportive test, it is of value when abnormal, but if normal doesn't exclude the diagnosis. So to resume in terms of tests a Xray should be done, while MRI and nerve conduction studies only if physical exam is doubtful.
As for treatment in terms of medication apart from analgesics like Ibuprofen there are not many other options. The mainstay of management is rather physical therapy. So if your primary believes that to be the diagnosis as well, he should prescribe physical therapy sessions. If that is not effective then surgery may be considered. In most patients that is not necessary though as physical therapy leads to improvement.
I remain at your disposal for other questions.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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