Neurogenic Thoracic Outlet Syndrome and Pectoralis Minor Syndrome: A Common Sequela of Whiplash Injuries

Thoracic outlet syndrome (TOS) presents with pain and paresthesia in the neck and upper extremity, weakness in the arm, and occipital headaches. Over 80% of cases are a result of compression of the brachial plexus after hyperextension neck injuries such as whiplash. The diagnosis is often missed because it cannot be made by x-ray or nerve tests; diagnosis requires clinical evaluation by history and physical examination. The popular Adson test is misleading and should be replaced by more specific provocative maneuvers that elicit symptoms. In addition, many patients with neurogenic TOS also have chest pain that often is from an associated pectoralis minor (PM) compression syndrome. Because PM syndrome is easily treated by a no-risk outpatient procedure, its distinguishing features and recognition are important. The clinical diagnostic features of both conditions are the focus of this article.