Neurogenic Thoracic Outlet Syndrome Associated with Asymptomatic Cervical Stenosis: A Case Report

It is crucial to differentiate more common cervical spine disorders from thoracic outlet syndrome (TOS), which causes neck and shoulder pain and paresthesia in the upper extremities. However, distinguishing between these conditions can be challenging if cervical spine imaging identifies lesions that may explain the symptoms. Herein, we describe the case of a patient who presented with chronic neck and shoulder pain, along with paresthesia in the right arm and hand, which had persisted for two years. Cervical spine imaging revealed ossified posterior longitudinal ligaments and disc protrusion at the C4-5 and C5-6 levels, potentially causing cervical radiculopathy. Nonetheless, the patient's symptoms worsened after strenuous physical activity of the upper extremities, raising suspicions of neurogenic TOS. A thorough history and physical examination confirmed neurogenic TOS and carpal tunnel syndrome, with symptom improvement following decompression surgery of the right brachial plexus and median nerve. Differential diagnosis of asymptomatic cervical lesions in neurogenic TOS can prevent unnecessary cervical spine surgery.