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Figure 1 | Italian Journal of Pediatrics

Figure 1

From: Managing pediatric thoracic outlet syndrome

Figure 1

A 6-year-old girl had neck, shoulder and bilateral upper limb pain and discomfort for more than 2 years. She had complained of left upper limb pain since she was 3 years old. (A) On examination, the left side of the girl’s face is obviously larger than the right side and (B) she reported that her neck was stiff. Bilateral cervical ribs can be seen on an anteroposterior X-ray film of the cervical spine (C), and a lateral X-ray film of the cervical spine shows disappearance of the physiological curvature of the cervical spine (D). After receiving a local nerve block in the neck, the girl was alert, agile, and cooperative during physical examination. The shoulder abduction and external rotation strength, elbow flexion strength and hand-clenching strength of the left upper limb were poorer than those of the right upper limb. Wright’s test and Adson’s test were positive, and Hoffmann’s sign was negative. Her left shoulder abduction strength decreased at 90 degrees (E). Her left shoulder abduction strength was decreased at 30 degrees (F), and the left shoulder external rotation strength was also decreased (G). Her elbow flexion strength was decreased (H), as was her hand grip strength (I). After she received a local nerve block, her shoulder, elbow and hand strength increased significantly and the acmesthesia noticeably improved.

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