Intended for healthcare professionals

Practice A Patient’s Journey

Thoracic outlet syndrome

BMJ 2012; 345 doi: (Published 09 November 2012) Cite this as: BMJ 2012;345:e7373
  1. Lauren Deane, patient1,
  2. Henk Giele, consultant2,
  3. Karen Johnson, general practitioner 1
  1. 1Poplar Grove Practice, Aylesbury, Bucks HP20 1XB, UK
  2. 2Plastic, Reconstructive and Hand Surgery, Nuffield Orthopaedic Centre, Headington, Oxford, UK
  1. Correspondence to: L Deane lauren85{at}, karenjohnson{at}
  • Accepted 25 August 2012

After undergoing sensory tests for numbness in her left arm, this patient was diagnosed as having thoracic outlet syndrome. Despite seven operations, she is still in pain

It all started around nine years ago when I was 17; I began to get a strange tingling and a dull ache in my left arm. I noticed I couldn’t carry a bag over my left shoulder, as my arm seemed to go numb and achy. At the time I was training at college to be a beauty therapist. I kept getting strange electric shock sensations and stabbing pains and the feeling of a dead heavy arm, but I remember putting it down to over-working at college and at work. I ignored it for as long as possible. I mentioned it in passing while seeing my general practitioner for an unrelated matter.

I explained to my doctor the pains and symptoms I had been getting. She then carried out some sensory tests on my arm. I watched a needle being pressed on my arm and hand and knew it should be hurting or at least feeling sharp, but I couldn’t feel it at all. The general practitioner pointed out that I had muscle wastage in my left hand; my palm was indented and my tendons could be felt, I had no pad of muscle under my thumb area, and the back of my hand also looked thin. I had not noticed this before.

My doctor arranged an urgent appointment for me to see a neurosurgeon. From then on I had so many tests I can’t even remember the number—nerve conduction studies with needles and electrodes, vascular scans, magnetic resonance imaging, radiography, etc—and everyone seemed to be confused by the results.

Eventually I was told I had a condition called thoracic outlet syndrome and …

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