B. Katirji et Rw. Hardy, CLASSIC NEUROGENIC THORACIC OUTLET SYNDROME IN A COMPETITIVE SWIMMER - A TRUE SCALENUS ANTICUS SYNDROME, Muscle & nerve, 18(2), 1995, pp. 229-233
Neurogenic thoracic outlet syndrome (TOS) is caused by compression of
the lower brachial plexus usually by a cervical rib or a fibrous band,
We describe a 16-year-old girl with weakness and wasting of her right
hand, which progressed over the ensuing years. She had been a competi
tive long distance freestyle and butterfly swimmer since age 8 years.
A neurological exam at age 20, revealed severe atrophy and weakness of
all intrinsic right hand muscles, more so of the thenar muscles, and
hypesthesia along the ulnar aspect of the hand and forearm. EMG, which
showed a severe chronic axon loss lower trunk brachial plexopathy wit
h minimal fibrillations, was typical for classic neurogenic TOS. Chest
and cervical spine X-rays and MRI of the cervical spine were normal.
A supraclavicular exploration confirmed the absence of a cervical rib
or band. The lower trunk was thickened under the scalenus anticus whic
h was sectioned. Neurolysis was also done. She was advised to abandon
swimming. A clinical and EMG follow-up 2.5 years later showed no signi
ficant changes. This is the first case of true neurogenic TOS caused b
y scalenus anticus compression occurring in a competitive swimmer. (C)
1995 John Wiley and Sons, inc.