How Pain in Her Shoulder Became Thoracic Outlet Syndrome

Thoracic Outlet Syndrome
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Veronica Debkiewicz was just a few months shy of earning her nursing degree when she lost feeling and function in her right arm.

“I woke up with a lot of pain in my shoulder,” said Debkiewicz, who now works as a perioperative nurse at Hartford Hospital. “It felt like my rotator cuff. I took some ibuprofen and continued on my morning.”

As the day went on, however, her symptoms worsened. The limb turned a sickly shade of bluish-gray and she lost grip strength and motor function in her hand. Even when she wore a sling to support the limb, her dominant side, the pain proved heavy and disruptive.

Debkiewicz found her way to Dr. Parth Shah, a vascular and endovascular surgeon with Hartford HealthCare’s Heart & Vascular Institute, discovered a deep vein thrombosis (DVT) or blood clot that was causing thoracic outlet syndrome (TOS).

The thoracic outlet is a narrow passageway between the lower neck and upper chest through which blood vessels and nerves pass. In some people, repetitive overhead motion, injury or congenital abnormality can cause compression of these vessels or nerves which, Dr. Shah said, can cause pain, limited mobility and nerve damage.

It’s a condition often afflicting people engaged in heavy lifting or repetitive overhead use of the arms. Markelle Fultz of the Philadelphia 76ers basketball, the No. 1 pick in the 2017 NBA draft, is the most recent professional athlete treated for TOS, but others including pitcher Matt Harvey of the Los Angeles Angels, a Connecticut native who also played for the New York Mets.

“These patients experience a variety of symptoms, which can make TOS challenging to diagnose,” Dr. Shah said. “Symptoms can range from intermittent arm swelling, discoloring of the hands and arms, and tingling which can often be painful.”

For Debkiewicz, it couldn’t have happened at a worse time as she worked through required clinical rounds as part of her nursing education.

“It was a very stressful time for me,” she said. “I had to miss my clinicals for more than a week and there was a chance I wouldn’t have everything managed in time for graduation.”

Once she was diagnosed, however, treatment began to help her symptoms quickly. First, an EKOS catheter was inserted into her arm for 48 hours to deliver medication and ultrasonic pulses designed to break up the deep vein thrombosis clot. Surgery was then scheduled to address the resulting TOS.

“We determined that the first rib had put enough pressure on the vein that it caused the DVT. We removed the rib so it would not keep doing that in the future,” Dr. Shah said, adding that Debkiewicz went home two days after surgery and underwent physical therapy to regain strength in the neck, back and shoulder.

There are actually three types of TOS, based on what is being compressed in the patient’s thoracic outlet. The type also determines the treatment, with surgery not always required to return motion and feeling to the person’s limb.

“Our primary focus is relieving the compression and returning the patient to normal activities as quickly as possible,” Dr. Shah said.

Diligent with her PT, Debkiewicz regained full range of motion and reports no pain in the arm these days.

“I had never heard of TOS before,” she said. “I never had any long-term symptoms leading up to that day, but I’ve learned so much about my own body and treatment through this experience. It has made me even more passionate about my work as a nurse in the OR where I have the opportunity to serve patients just like me.”

For more information on thoracic outlet syndrome and available treatment at Hartford HealthCare’s Heart & Vascular Institute, click here.


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