Abstract
Objectives. The paper presents the thoracic outlet syndrome (TOS), a rare disorder affecting the lower trunk of the brachial plexus and subclavian vessels between the neck and axilla. Several types of TOS are distinguished: vascular (venous or arterial) and neurogenic (true or non-specific).
Case report. A case of TOS is presented: a 21-year-old woman complaining of pain in the right upper extremity, with weakness and atrophy of the intrinsic hand muscles, as well as paresthesia of the 4'h and 5th fingers. The clinical examination (including vascular tests) and EMG confirmed a lesion of the lower trunk of the brachial plexus. In this case angiography showed a blood flow decrease in the right subclavian artery with hands up, so the neurogenic and vascular type of TOS was recognized. The patient underwent a partial resection of the 1st rib, which prevented progression of the condition. After the surgery an improvement was noted in vascularization of the right hand, but the neural structures of the brachial plexus were found to be damaged permanently.
Commentary. The diagnosis of TOS is extremely difficult, requires not only the clinical examination (including vascular tests), but also a wide range of additional investigations (electroneurophysiological tests, angiography, classical radiology, MRI and USG-D).