What Question Best Indicates Thoracic Outlet Syndrome?

 

A. Numbness in the 4-5th Digit?

B. Thenar Numbness at Night?

C. Wake Up & Entire Hand is Numb?

 

***CLINICAL REASONING: The correct answer is “C”. Years ago, I began noticing that patients with neurogenic TOS frequently reported, “When I wake up, my entire hand is numb.” Surprisingly, most of my TOS patients had never been screened by their neurological specialist, physical therapist, or chiropractor.

 

They were misinformed that the radiculopathy was caused by a bulging disc or a bone spur in the cervical spine. This explanation seemed implausible. To cause complete numbness in the hand, one would need to have herniated discs or bone spurs in multiple levels of the cervical spine, not just one or two.

 

A more plausible explanation occurred to me: these patients were sleeping in a position that compressed their thoracic outlet. Two simple clinical tests can confirm this.

 

Whenever I evaluate a patient with upper extremity radiculopathy, I immediately ask, “Do you wake up and your entire hand is numb?” Often, patients use similar language to describe their conditions, which can be a clue to the potential diagnosis. Take the time to listen to how each patient describes their condition; you may start to notice a pattern like I did.

 

For my detailed protocols on how I treat TOS with approximately 99% success rates, please visit wheltonmethods.com for my published papers and protocols.

 

Ryan Whelton, DPT

 

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