Paresthesia and Pain in Both Arms when Shampooing One’s Hair: Symptoms of Neurogenic Thoracic Outlet Syndrome

Abstract

Neurogenic thoracic outlet syndrome (TOS) is a clinical diagnosis based on the reproduction of a patient’s symptoms with a provocation test (arm elevation) after excluding other conditions that might cause similar symptoms. Neurologic symptoms and signs can vary from mild paresthesia and numbness to intrinsic hand muscle atrophy. The main controversy in patients with neurogenic TOS involves neurologic-type complaints of paresthesia, numbness, and pain. However, there is no positive objective test to identify the cause. A 54-year-old female patient presented with numbness and radiating pain in her bilateral arms that occurred every time she bowed her head while shampooing. The patient had a history of two neck sprains due to slipping before the onset of symptoms. In addition to pain and numbness in both arms at arm elevation, pain in the suprascapular and occipital areas was also present. After excluding cervical nerve root lesions and other bone abnormalities, the patient's symptoms disappeared by brachial plexus decompression through a supraclavicular approach. It is difficult to diagnose neurogenic TOS with pain and paresthesia without muscle weakness in the upper extremities. If physicians do not consider the possibility of neurogenic TOS in patients with upper extremity paresthesia and pain, unnecessary multiple treatments may be performed, prolonging patients’ suffering. The exacerbation of pain and paresthesia in both arms and hands can occur immediately after the head is lowered during shampooing. This can be interpreted as a characteristic symptom of a constricted interscalene triangle and brachial plexus compression caused by hyperabduction of the arm.