Student Sam Houston State University College of Osteopathic Medicine Spring, Texas, United States
Case Diagnosis: Neurogenic thoracic outlet syndrome (nTOS)
Case Description: A 25-year-old male patient presented with a persistent 2.5-year history of discomfort in the left neck, trapezius, pectoral, and latissimus regions, accompanied by numbness and tingling that radiated along the left upper extremity, extending from the biceps, volar forearm, and all digits. These symptoms were exacerbated when he rolled his shoulders back from their rounded position. The most pronounced discomfort was localized in the scalene and pectoral regions. After a comprehensive discussion, we opted for a muscle relaxant treatment approach, and initiated methocarbamol therapy.
Discussions: Thoracic outlet syndrome (TOS) encompasses a spectrum of symptoms due to neurovascular bundle compression above the first rib and behind the clavicle. Managing neurogenic thoracic outlet syndrome (nTOS) involves various treatments, such as pharmacological and surgical options, each with its unique risks and outcomes.
The persistence of symptoms after decompression surgery suggests additional underlying factors. One hypothesis suggests the involvement of a hypertrophied trapezius muscle, which may exacerbate nTOS by exerting pressure on the clavicle, contributing to neurovascular bundle compression.
Using muscle relaxants in nTOS treatment shows promise by targeting tension in both scalene and trapezius muscles. This approach offers a comprehensive strategy to alleviate neurovascular bundle compression, potentially improving outcomes for nTOS patients.
Conclusions: The patient is currently receiving a methocarbamol regimen at a dosage of 4500 mg. The patient reports that this medication provides relief approximately 60% of the time. However, he continues to experience significant stiffness, particularly in the morning and at night. Following each dose, the patient notes an improvement in tightness and stiffness, lasting approximately 1.5 to 2 hours. Overall, there has been a 20% improvement in tightness and spasticity. The patient has also experienced a notable 50% improvement in numbness and tingling along the biceps, forearm, and digits since initiating methocarbamol therapy.
