![]() ![]() The patient is a carpenter and considers the possibility that muscle hypertrophy due to hard work may exacerbate the symptoms, even at middle age. Considering the muscle trajectory, it is possible that elevation of the upper limb also elevated the clavicle, thereby reducing muscle tension and nerve compression. In the present case, the patient’s symptoms were relieved by elevation of the upper extremity. In TOS, elevation of the upper extremity typically evokes symptoms because it leads to exacerbation of the stenosis. This case was characterized by a positive Bakody’s sign and an anomalous muscle that had not been previously reported, which initially made us suspect cervical spondylotic radiculopathy. The diagnosis of TOS is usually based on clinical symptoms and physical tests, such as the Adson, Wright, Allen, and Roos tests. It originated from the nuchal ligament and stopped in the middle one-third of the upper clavicular side (Figure (Figure3 3). MRI of the left brachial plexus showed the same pattern (Figure (Figure2). Computed tomography (CT) with contrast of the chest revealed an anomalous muscle next to the left brachial plexus. A nerve conduction study revealed a velocity below 60 m/s in the brachial plexus trunk. The Adson, Wright, Allen, and Roos test results were negative. There was no difference in the measured blood pressure in the upper limbs or palpated radial and brachial pulses. No sensory impairment or muscle weakness was observed. There was no difference in the numbness and two-point discrimination test beyond the forearm between the radial and ulnar sides. The patient had rest pain in the left upper extremity in the drooping position, consistent with the same site, as well as tenderness and worsening numbness due to compression. On a repeated physical evaluation, a soft mass was revealed in the left supraclavicular fossa (Figure (Figure1). Magnetic resonance imaging (MRI) of the cervical spine revealed no findings. Cervical spondylotic radiculopathy was suspected however, there were no findings on radiography of the chest and cervical spine. The Jackson and Spurling tests were negative, but Bakody’s test was positive. The patient had no history of illness or trauma. The patient was treated with nonsteroidal anti-inflammatory analgesics, with no response instead, the symptoms increased in severity and became persistent during the previous two months. He was a carpenter and had difficulty working due to these symptoms. He had no limitation in range of motion or muscle weakness. His symptoms worsened when the left hand was lowered and relieved when shoulder abduction/forward elevation/external rotation was performed. We present the case of a 40-year-old man with a three-year history of dull posterior neck pain and numbness of the left upper extremity. ![]()
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