The Diagnosis and Treatment of a Rare Case of Supraclavicular Neuropathy Following Thoracic Decompression Surgery | Biomedgrid

The supraclavicular nerve is rarely of clinical significance for many medical providers and even less so for most pain physicians. The following is a case of supraclavicular neuropathy following thoracic outlet decompression to treat Paget–Schroetter syndrome, a venous thrombosis etiology of thoracic outlet syndrome (TOS). A 38-year-old female was referred to our pain management clinic by her vascular surgeon for a new onset of severe right-sided superior chest wall and peri-clavicular pain that began after surgery to address her TOS. She described constant tingling, burning, and numbness which was distinct from the painless swelling and mottling of her right arm prior to her TOS diagnosis. Narcotics and muscle relaxants had provided minimal relief for these new post-operative symptoms. Multiple subsequent ultrasound exams were negative for recurrent venous thrombosis. After 6 weeks of treatment in the pain clinic, which included the initiation of gabapentin, desensitization therapy, repeated local lidocaine injections, and electroacupuncture, she reported 70% improvement in pain. She also endorsed improved functional outcomes, specifically an increased ability to perform overhead activities, wear upper body clothing without severe pain, and improved sleep. This patient represents a rare case of supraclavicular neuropathy following surgery to address a venous etiology of TOS, Paget–Schroetter syndrome. The purpose of this report is to bring awareness of this surgical complication to pain physicians in order to lead to early diagnosis and treatment, and to prevent the development of chronic pain.