Vascular Thoracic outlet syndrome- A misdiagnosis that could cost a limb and alerting clinicians for early suspicion

Thoracic outlet syndrome (TOS), particularly venous (vTOS), is frequently misdiagnosed due to symptom overlap with musculoskeletal disorders. This case report shows a 45-year-old homemaker and seamstress with chronic right arm edema, cyanosis, and weakness exacerbated by repetitive movements—initially misattributed to shoulder pathology. Clinical assessment indicated positive Wright’s/Roos’ tests and vascular impairment without neurological abnormalities, prompting vTOS suspicion. The case emphasizes significant diagnostic challenges: (1) dependence on provocative techniques needs confirmatory imaging (Doppler/venography), and (2) occupational/repetitive stressors (sewing, past clavicular fracture) heighten vTOS risk. Early surgical referral warrant critical, as conservative management was contraindicated. This report alerts clinicians to recognize vascular red flags in upper limb dysfunction, emphasizing timely intervention to prevent thrombotic complications.