Disclosures: Brennan M. Wright, MD: Nothing to disclose

Case Description: The patient presented with an 11-year history of right upper limb pain and paresthesia following forced shoulder extension while being struck by a motor vehicle. He reported persistent pain in his right neck, shoulder, and pectoral region as well as numbness and tingling in his right arm and forearm. His symptoms persisted despite undergoing a C5/6 fusion and rotator cuff repair. He was ultimately diagnosed with neurologic thoracic outlet syndrome (nTOS). Over the next several years he received various treatments including physical therapy, massage, acupuncture, chiropractic treatment, transcutaneous electrical nerve stimulation, surgery, and injections without sustained relief of his symptoms.

Setting: Outpatient Physical Medicine and Rehabilitation clinic

Patient: 48-year-old man with right upper limb paresthesias and pain

Assessment/Results: Ultrasound of the right shoulder and brachial plexus revealed the superior slip of the pectoralis minor muscle to be thinning at the origin and to have bulbous enlargement over the cord level reflective of a previous strain injury. The enlarged area was creating mass effect at the cord level of the brachial plexus including the median cord. This abnormal area correlated precisely with his point of maximal tenderness and the visualized dynamic compression correlated with the reproduction of his symptoms.

Discussion: Ultrasound is an ideal modality to assess a complicated shoulder and pectoral injury of this nature. The high resolution allowed accurate visualization of the neurologic structures and nature of the muscular strain. The ability to assess tissue dynamically provided the perspective of tissue stress with movement.

Conclusion: Ultrasound can be used to diagnose the anatomic basis of retropectoral thoracic outlet entrapment. The dynamic capabilities of ultrasound provided an advantage over static imaging in this case. The precise delineation of the source of entrapment provided information that contributed to a successful treatment plan.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-evaluation-of-neurogenic-retropectoral-thoracic-outlet-entrapment-a-case-report/