Paresthesia in the upper limb

case:
female 24 years old, paresthesia in both upper limb, tingling in 4 and 5 fingers, mostly appears at night, tendersness and pain in the both upper limbs, neck, shoulder, back muscles, weakness/ decreased muscle stength of both upper limbs,
start at 5 years ago with the pain in the wrist, worsen by time, pain and parssthesia has spreaded proximaly, have had to birth
, with pelvic floor dysfunction during both pregency, suffering still from that, can feel dizzy or breathlessness from time to time.

ROM in neck is optimal, some pain at lat flex to left side.
examination of thoracic oulet syndrom is postive

but if thoracic oulet syndrom can be bilat?
MRI of head , neck and bracial plexus, or EMG?

Interesting case...

Would you mind to clarify few things for me please?

Is the parasthesia objectifiable? If yes, does involves a nerve distribution or a dermatome?
Is the muscle weakness objectifiable? If yes, which muscle or myotomes?
How are her reflexes?
How is her breathing pattern?
How is her posture?
Has she seen any specialist/physician for that problem? If yes what are their considerations?
Which kind of tests have you performed to say that TOS is positive? And what did you use as positive or negative response? TOS tests may be very unreliable

All the best

Emanuele

The treatment of paresthesia of lower limb are very much personalized depending on the reason, the age, the presence of co-existing diseases, as well as many more factors. Treatment comprises a comprehensive plan focusing on the underlying and assists in reducing the typical sensation of paresthesia. This would enable the patient can lead a normal, active life.