Differentially diagnosing chronic upper limb paresthesia in a 24-year-old patient: is thoracic outlet syndrome the culprit? A case report.

Q3 Health Professions Journal of the Canadian Chiropractic Association Pub Date : 2023-04-01

Janny Mathieu, Joe Lemire, Igor Steiman, Benjamin Provencher

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Abstract

Objective: To describe the differential diagnosis, diagnosis, and chiropractic management of a case of chronic upper extremity paresthesia.

Clinical features: A 24-year-old woman presented with recent neck stiffness, along with a primary complaint of chronic upper extremity paresthesia and hand weakness of insidious onset.

Intervention and outcome: Results of previous electro-diagnostic and advanced imaging studies were combined with clinical assessment to diagnose thoracic outlet syndrome (TOS). Discontinuing after five weeks of chiropractic management, the patient reported significant improvement of paresthesia but less improvement of her hand weakness.

Summary: Several etiologies can give rise to symptoms in common with TOS. It is imperative to rule out mimicking conditions. A battery of clinical orthopedic tests has been proposed in the literature for the diagnosis of TOS but with reported questionable validity. As a result, TOS is mostly a diagnosis of exclusion. Chiropractic treatment shows potential for effective management of TOS, but research is required.

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24岁患者慢性上肢感觉异常的鉴别诊断:胸廓出口综合征是罪魁祸首吗?一份病例报告。

目的:描述一例慢性上肢感觉异常的鉴别诊断、诊断和捏脊治疗。临床特征:一名24岁女性，近期出现颈部僵硬，并伴有慢性上肢感觉异常和手部无力的主诉。干预措施和结果:将既往电诊断和高级影像学检查结果结合临床评估诊断胸廓出口综合征(TOS)。在整脊治疗五周后，患者报告感觉异常明显改善，但手部无力改善较少。总结:几种病因可引起与TOS相同的症状。必须排除模拟条件的可能性。文献中提出了一系列临床骨科测试来诊断TOS，但据报道有效性值得怀疑。因此，TOS主要是一种排除性诊断。捏脊疗法显示出有效治疗TOS的潜力，但还需进一步研究。

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来源期刊

Journal of the Canadian Chiropractic Association Health Professions-Chiropractics

CiteScore

0.90

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0.00%

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期刊介绍： The Journal of the Canadian Chiropractic Association (JCCA) publishes research papers, commentaries and editorials relevant to the practice of chiropractic.