Which symptom most characterizes thoracic outlet syndrome due to compression of nerves and/or blood vessels?

• A. Neck, shoulder, and arm pain, weakness, and numbness/tingling due to compression of nerves and/or blood vessels in the thoracic outlet
• B. Chest pain with shortness of breath
• C. Severe unilateral leg swelling and redness
• D. Headache with photophobia

Answer: (A)

Thoracic outlet syndrome presents with upper-extremity neurovascular symptoms when the nerves and/or vessels are compressed as they pass through the thoracic outlet. When this space is narrowed, the lower brachial plexus and the subclavian vessels can be affected, leading to pain in the neck, shoulder, and arm, along with weakness and numbness or tingling in the arm or hand. This constellation—pain plus sensory disturbance and sometimes weakness in the affected limb—is the hallmark of TOS caused by neural and/or vascular compression.

Other options describe problems that usually point to different systems: chest pain with shortness of breath suggests cardiac or pulmonary illness; severe unilateral leg swelling and redness suggests a venous problem in the leg; and headache with photophobia points toward migraine or other primary headache disorders.