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 4^th and 5^th fingers of the left hand often experience numbness and tingling. What condition is the pitcher suffering from? What structures in the neck are involved?

Answer 1

Pitcher is mostl likely having "Thoracic outlet syndrome".

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

This may lead to compression of Subclavian artery, Subclavian vein or Brachial Plexus.

Compression of Subclavian artery is responsible for blood pressure difference between the two arms.

Also impaired circulation to the periphery (hand) is responsible for 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 outlet syndrome can be caused by

1) scalenus muscle firbosis

2) extra cervical rib

3) anomalous 1st rib