Right Arm Numbness In An Adolescent

Abstract

HISTORY: A 14-year-old high school student presented to Orthopedics Urgent Care for right arm numbness and discoloration. Four days prior had noticed that her right arm would turn a dusky purple or blue color from the shoulder to her fingers with associated numbness and tingling in the entire arm. Episodes lasted only a few seconds to a minute. She would have multiple episodes a day. No specific pattern or time of day, however she thinks it may occur more frequently while wearing a backpack or if her arm is in an elevated position. Episodes resolve on their own. ROS otherwise negative. PHYSICAL EXAMINATION: Right upper extremity without dusky appearance, appears similar to left upper extremity. Full ROM and strength at the shoulder, elbow, wrist, and fingers. Decreased sensation in the ulnar distribution of the right hand compared to the left. Strong radial pulse when right hand is lowered. Positive Adson for loss of radial pulse, positive Roos for numbness and tingling. DIFFERENTIAL DIAGNOSIS: 1. Right upper extremity DVT 2. Thoracic outlet syndrome 3. Pancoast tumor TEST AND RESULTS: Right upper extremity venous ultrasound normal. Right upper extremity arterial ultrasound with normal triphasic arterial waveforms with arm at patient’s side and at 90 degrees abducted in the subclavian, axial, brachial, radial, and ulnar arteries. With arm raised above patient’s head, abnormal monophasic waveform in the right subclavian artery. FINAL WORKING DIAGNOSIS: Arterial thoracic outlet syndrome. TREATMENT AND OUTCOMES: 1. Referred to pediatric vascular surgery. 2. Was referred to physical therapy, will follow up in 6 months.