Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Thoracic Outlet Syndrome
: : I would like info on Thoracic Outlet Syndrome. Thanks = : True neurogenic thoraccic outlet syndrome is a very rare condition caused by either an abnormal extra "cervical" rib, or alternatively, a fibrous band that forms in its place congenitally, pressing on the bottommost portion of a bundle of nerves called the brachial plexus. This most often results in painless wasting of certain muscles in the hand and forearm, and often in numbness along the part of the hand and forearm closest to the little finger and elbow. If the condition is more severe, it may rarely obstruct either venous, or in exsceptionally rare cases, arterial circulation to the affected arm in which case the entire thing can go numb or even become paralyzed temporarily (often at night when you sleep. The condition is not in any way, shape, or form connected to back pain. Treatment of the condition, if it can be definitively proven to be causing nerve damage by an EXTREMELY thorough EMG study, consists of cutting out the rib or cutting the fibrous band pinching the nerves and/or arteries and veins leading into the arm. I would have this done at a very large, academic teaching hospital or medical center. If Cleveland is near you at all, we do have a doctor at the Cleveland Clinic named Asa Wilbourne, who is quite literally the best expert in the world in the diagnosis and treatment of this particular disease. You could arrange to see one of our neuromuscular section doctors in combination with an EMG by Dr. Wilbourne by calling 216-444-5559. Irrespective of who treats you, I would not be in any hurry to impale yourself on a thoraccic surgeons scalpel--- the operations that "repair" the condition are often marginally effective and carry significant, often underemphasized risk.
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