39-Year-Old Woman with Thoracic Outlet Injury

In this example, we explore the case of a 39-year-old woman who was in her usual state of good health when, one day while working on an entertainment set, was struck in her collarbone area by a large ladder.

She noticed left shoulder weakness immediately, and later she developed some elbow symptoms. Her local doctor prescribed a shoulder immobilizer for a month and this led to even further progression of the symptom of numbness, tingling and burning in her hands. She began to experience coldness in the hands and this became continuously painful.

She saw a variety of physicians, and a diagnosis of thoracic outlet syndrome was ultimately made. She was treated by several east coast neurologists and neurosurgeons ultimately having surgery on her right first rib resection and scalene muscle. This gave her very little benefit. The pain persisted essentially unaffected, although she did have some improvement of the strength of the 4th and 5th fingers of her hand, which had become noticeably weak.

When she arrived at The Neurography Institute, she had bilateral pain, right greater than left. The pain has a significant focus in the ulnar region of the arm, but also into the 4th and 5th fingers. Notably, she brought an MR Neurography study completed at an outside unlicensed neurography facility. The study didn’t show nerve details for ancillary nerve branches, and did not include 3D analysis, so it did not show usable inconclusive results that could explain the numbness and weakness, as well as the pain symptoms.

Based on the exam and medical history data, we found there was significant evidence for an ongoing thoracic outlet syndrome diagnosis. A cervical spine MRI and a soft tissue MR Neurography completed by The Neurography Institute confirmed this and allowed us to evaluate the brachial plexus in detail, so further nerve releases or scalene resections could be planned. The MR Neurography showed the exact location of the brachial plexus nerve entrapments. Additionally, the MR Neurography showed significant scar tissue build up from the previous surgery that may have been playing a part in entrapped nerves within the brachial plexus. A two-part staged surgery beginning with interventional MR surgery mapping was planned and done based on The Neurography Institute’s MR Neurography scan.

Approximately six weeks out from her re-operative thoracic outlet surgery, the patient is pleased to report an excellent overall outcome and has had great improvement with regard to her lateral neck, arm, and hand and shoulder abduction and her RSD symptoms. She is quite pleased that the detailed imaging and 3D analysis of the MR Neurography from The Neurography Institute provided both conclusive diagnosis and targeted surgical planning. At this time the patient is rapidly decreasing her pain medication and emphasizes that she will return to work within the next few weeks.

Actual neurography images from this case follow to help illustrate how your physician and our radiologists and neurosurgeons use MR Neurography technology to accurately diagnose and treat nerve conditions.

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