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EM@3AM: Thoracic Outlet Syndrome

A 35-year-old female presents with intermittent right arm pain and numbness that has been worsening for the last month. Symptoms are worsened by lifting her arm above her head. She has also noticed new hand swelling and a “cold” sensation in her fingertips. On exam, she has diminished sensation in the 4th and 5th digit with noticeable hand swelling. What is the diagnosis?

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    EM@3AM: Thoracic Outlet Syndrome

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    A 35-year-old female presents with intermittent right arm pain and numbness that has been worsening for the last month. Symptoms are worsened by lifting her arm above her head. She has also noticed new hand swelling and a “cold” sensation in her fingertips. On exam, she has diminished sensation in
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    Acute heart failure exacerbation disposition

    Not all patients require admission

     

    Consider patient hemodynamics, respiratory status, ECG, labs (Cr, troponin, sodium/electrolytes), ability to ambulate, follow up

     

    Elevated troponin and serum Cr associated with worse outcomes

     

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