Abstract
The diagnosis of brachial plexus compression—either neurogenic thoracic outlet syndrome (NTOS) or neurogenic pectoralis minor syndrome (NPMS)—is based on old fashioned history and physical examination. Tests, such as scalene muscle and pectoralis minor muscle blocks are employed to confirm a diagnosis suspected on clinical findings. Electrodiagnostic studies can confirm a diagnosis of nerve compression, but cannot establish it. This is not a diagnosis of exclusion; the differential and associated diagnoses of upper extremity pain are always considered. Also discussed is conservative and surgical treatment options.
Highlights
Brachial plexus compression occurs either above the clavicle in the thoracic outlet area or below the clavicle under the pectoralis minor muscle (PMM)
Detailed history and physical examination are needed to determine whether brachial plexus compression is above the clavicle in the thoracic outlet area or below the clavicle, beneath the pectoralis minor muscle
No diagnostic test is pathognomonic for neurogenic thoracic outlet syndrome (NTOS) or for neurogenic pectoralis minor syndrome (NPMS)
Summary
Brachial plexus compression occurs either above the clavicle in the thoracic outlet area or below the clavicle under the pectoralis minor muscle (PMM). Because the symptoms of the two conditions are similar, the history and physical examination is the same for neurogenic thoracic outlet syndrome (NTOS) and neurogenic pectoralis minor syndrome (NPMS). The combination of paresthesia in the hand and pain in the arm should raise the question of brachial plexus involvement. Detailed history and physical examination are needed to determine whether brachial plexus compression is above the clavicle in the thoracic outlet area or below the clavicle, beneath the pectoralis minor muscle. No diagnostic test is pathognomonic for NTOS or for NPMS. Evaluation should begin with the clinical picture [1]
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