Question

A left-handed pitcher has aching of the left forearm brought on by exercise and relieved by rest. The left hand often becomes colder than the right and is paler when held above the head. The blood pressure in the left arm is 90/60 and in the right arm is 128/82. The 4th and 5th fingers of the left hand often experience numbness and tingling. What condition is the pitcher suffering from? What structures in the neck are involved? What is the pathophysiology for the symptoms?

Answer 1

Pitcher is suffering from Thoracic outlet syndrome.

In Thoracic outelt syndrome blood vessel and nerves gets compressed in space between 1st rib and clavicle.

It lead to compression of vital structure like Subclavian artery, Subclavian vein or Brachial Plexus.

Subclavian artery compression leads to blood pressure difference between the two arms and impaired blood flow to hand leads to cold extrimity and pallor in hand when held above head.

Tingling and numbness may be due to compression of brachial plexus leading to ulnar nerve root compression. Hence incoling 4th and 5th digit.

Thoracic outelt syndrome may be caused by anamolous 1st rib, fibrosis of sacleni etc.