Thoracic Outlet Syndrome

Thoracic outlet is a space that borders the clavicle, the first rib and the scalene muscles. In this space an extra rib can also be inherently present. The subclavian artery and vein, as well as the nerve roots of the brachial plexus, pass through this space. Compression on any of these structures can result in symptoms and cause an arterial, venous or neurogenic type of thoracic outlet syndrome. In the arterial type dominate symptoms of painful and cold arm. In the venous type of pain and edema and in the neurogenic type of pain - tingling and burning sensation in the upper extremity can be present. A case report is of a patient who had unspecified neurologic symptoms of tingling, burning sensation and pain in the right arm that exacerbated especially when the patient was sleeping on the left side of the bed. The patient had consulted several specialists regarding the symptoms; internists, orthopedic doctors, neurologists and rheumatologists, whose therapies proved unsuccessful. When in the right supraclavicular fossa appeared a formation with solid consistency and the needle biopsy proved presence of osteocytes, a CT examination of this region was proposed. The result of the CT scan proved presence of an accessory cervical rib that compresses the brachial plexus and was the cause for the neurological symptoms. Thoracic outlet is still a diagnostic challenge, and regarding the treatment plan several experienced specialists from different specialties should be consulted due to its multicausality.