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

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