Thoracic outlet syndrome
The "thoracic outlet" is the space on either side of the base of the neck where nerves, arteries, and veins travel beneath the collarbone. If these become compressed or damaged, the condition is called thoracic outlet syndrome or TOS.
The most common causes are trauma, such as a car accident or fall; and repetition or overuse, such as a sports injury.
Symptoms vary depending on the structures being compressed:
- Neurogenic TOS affects the nerves. It is the most common form and creates numbness, tingling, pain, and weakness in the arms, hand, and fingers.
- Vascular TOS affects the arteries and veins. It creates the same symptoms as neurogenic TOS as well as cold, pale hands and arms with weak pulse.
It is important to see a medical provider about these symptoms so that the damage does not become permanent.
Diagnosis is made through patient history, physical examination, imaging such as x-ray or ultrasound, and sometimes nerve conduction and blood flow studies.
Treatment involves physical therapy, pain relievers, and sometimes surgery.
Rarity: Rare
Top Symptoms: pain in one shoulder, spontaneous shoulder pain, arm weakness, arm numbness, pain in one shoulder blade
Urgency: Primary care doctor
Subarachnoid hemorrhage
Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. It's typically caused by a ruptured aneurysm (out-pouching of an artery's wall).
Call 911 immediately. This condition is a medical emergency requiring immediate attention.
Stroke or tia (transient ischemic attack)
Transient ischemic attack, or TIA, is sometimes called a "mini stroke" or a "warning stroke." Any stroke means that blood flow somewhere in the brain has been blocked by a clot.
Risk factors include smoking, obesity, and cardiovascular disease, though anyone can experience a TIA.
Symptoms are "transient," meaning they come and go within minutes because the clot dissolves or moves on its own. Stroke symptoms include weakness, numbness, and paralysis on one side of the face and/or body; slurred speech; abnormal vision; and sudden, severe headache.
A TIA does not cause permanent damage because it is over quickly. However, the patient must get treatment because a TIA is a warning that a more damaging stroke is likely to occur. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through patient history; physical examination; CT scan or MRI; and electrocardiogram.
Treatment includes anticoagulant medication to prevent further clots. Surgery to clear some of the arteries may also be recommended.
Rarity: Common
Top Symptoms: dizziness, leg numbness, arm numbness, new headache, stiff neck
Symptoms that never occur with stroke or tia (transient ischemic attack): bilateral weakness
Urgency: Emergency medical service
Repetitive strain injury of the upper arm
Repetitive strain injury of the upper arm is caused by consistent repetitive use.
You do not need treatment, just rest from your overuse. Wearing a brace and physical therapy might be helpful.
Rarity: Uncommon
Top Symptoms: upper arm pain from overuse, upper arm weakness, upper arm numbness
Symptoms that always occur with repetitive strain injury of the upper arm: upper arm pain from overuse
Symptoms that never occur with repetitive strain injury of the upper arm: upper arm injury, severe upper arm pain
Urgency: Self-treatment
Pinched nerve in the neck
A pinched nerve in the neck is also called cervical radiculopathy. It means that a nerve in the neck, at a point where it branches off from the spinal cord, is being compressed by the surrounding bones, muscles, or other tissues.
It can be caused by a traumatic injury, such as from sports or an automobile accident, especially if the injury results in a herniated disk. It may also arise from the normal wear and tear of aging.
Symptoms include sharp, burning pain with numbness and tingling from the neck to the shoulder, as well as weakness and numbness into the arm and hand.
Diagnosis is made through patient history, physical examination, and simple neurological tests to check the reflexes. Imaging such as x-ray, CT scan, or MRI may be done, as well as electromyography to measure nerve impulses in the muscles.
A pinched nerve in the neck often improves with simply a few days or weeks of rest. Physical therapy, nonsteroidal anti-inflammatory drugs, and steroid injections into the spine can all be very helpful.
Rarity: Common
Top Symptoms: pain in one shoulder, spontaneous shoulder pain, pain that radiates down arm, pain in the back of the neck, severe shoulder pain
Urgency: Primary care doctor
Multiple sclerosis (MS)
Multiple sclerosis, or MS, is a disease of the central nervous system. The body's immune system attacks nerve fibers and their myelin covering. This causes irreversible scarring called "sclerosis," which interferes with the transmission of signals between the brain and the body.
The cause is unknown. It may be connected to a genetic predisposition. The disease usually appears between ages 20 to 50 and is far more common in women than in men. Other risk factors include family history; viral infections such as Epstein-Barr; having other autoimmune diseases; and smoking.
Symptoms include numbness or weakness in arms, legs, or body; partial or total loss of vision in one or both eyes; tingling or shock-like sensation, especially in the neck; tremor; and loss of coordination.
Diagnosis is made through patient history, neurological examination, blood tests, MRI, and sometimes a spinal tap.
There is no cure for MS, but treatment with corticosteroids and plasma exchange (plasmapheresis) can slow the course of the disease and manage symptoms for better quality of life.
Rarity: Rare
Top Symptoms: severe fatigue, constipation, numbness, decreased sex drive, signs of optic neuritis
Urgency: Primary care doctor
Herniated (slipped) disk in the upper back
A herniated, ruptured, or "slipped" disc means that a vertebral disc – one of the soft pads of tissue that sit between each of the vertebral bones – has becomes squeezed out of shape. Its cushioning material has been forced against, and possibly through, the ring of fibrous tissue that normally contains it. This causes pain, numbness, and weakness in the legs.
The normal aging process causes the discs lose moisture and become thinner, making them more vulnerable to "slipping."
Most susceptible are men from ages 30 to 50. Smoking, obesity, lack of exercise, and improper lifting are also risk factors.
Symptoms include pain, weakness, numbness, and tingling in the back, leg, and foot.
Diagnosis is made through patient history, neurological examination, and MRI scan.
Treatment begins with rest, nonsteroidal anti-inflammatory drugs, physical therapy, and sometimes epidural steroid injections into the back to ease pain and inflammation.
Surgery to remove the herniated part of the disc – the part that was squeezed out of place – can also be helpful.
Rarity: Common
Top Symptoms: upper back pain, neck pain, arm weakness, back pain that gets worse when sitting, upper spine pain
Symptoms that always occur with herniated (slipped) disk in the upper back: upper back pain
Urgency: Primary care doctor
Heart attack in a woman
Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat - called an arrhythmia - that causes a severe decrease in the pumping function of the heart.
Call 911 and seek emergency care immediately
Dislocated shoulder with nerve or artery damage
The shoulder is a ball and socket joint. This means the round top of the arm bone fits into the groove in the shoulder blade. A dislocated shoulder is when the entire ball is out of the socket. If the dislocation affects blood supply or a nerve, medical attention is extremely important.
You should go to the ER immediately for treatment. A dislocated shoulder that affects blood supply or damages a nerve may require immediate surgery to keep the whole arm healthy.
Rarity: Rare
Top Symptoms: pain in one shoulder, arm weakness, shoulder pain from an injury, severe shoulder pain, arm numbness
Symptoms that always occur with dislocated shoulder with nerve or artery damage: pain in one shoulder, shoulder dislocation
Urgency: Hospital emergency room
Brachial plexopathy (shoulder nerve issue)
A shoulder nerve injury, also called brachial plexopathy, is when damage occurs to a network of nerves in the front of the shoulder known as the brachial plexus. This damage can occur from injury, inflammation, radiation therapy, or other medical conditions. Symptoms include sharp pain in the shoulder, arm, or hand. Numbness or weakness in the shoulder or arm may also occur.
You should consider visiting a medical professional to discuss your symptoms. A doctor can evaluate shoulder nerve issues with a review of your symptoms and medical history. You might also be asked to do an EMG, a test that checks the connection between muscles and nerves. Once diagnosed, some options for treatment include pain or nerve block medication, physical therapy, and braces or splints. Some cases may require surgery. Depending on the severity, recovery times can range from weeks to years.
Rarity: Uncommon
Top Symptoms: pain in one arm, shoulder pain that shoots to the arm, arm weakness, numbness in one arm, shoulder pain
Symptoms that never occur with brachial plexopathy (shoulder nerve issue): pain in the front middle part of the neck
Urgency: Primary care doctor