Neuro-arterial variants of thoracic outlet syndrome manifesting with atypical chest pain in a professional air rifle shooter managed by physical therapy and rehabilitation: Case report

Thoracic outlet syndrome (TOS) is a diverse group of clinical disorders manifested upon impingement or compression of the neurovascular structures at the thoracic outlet, presenting a wide spectrum of neurovascular signs and symptoms. A high index of clinical suspicion complemented with a detailed clinical examination and optimal use of radiologic and electrodiagnostic studies must be employed to reach an early diagnosis for successful management since the symptoms are severely disabling and a residual neurological or vascular sequelae is expected in cases with the delayed or wrong diagnosis. We are discussing an interesting case where an air rifle shooter who presented to us with intermittent episodes of right-sided precordial chest pain for the last 3 months with a short history of breathing difficulty and occasional episodes of tingling and numbness in the right arm, diagnosed with hydro-pneumothorax on initial imaging and with neurological and arterial variants of TOS on subsequent workup during the course of hospital stay. The article intends to explain the relation of chest pain in patients with TOS.