Red Flag Radiculopathy, Pancoast Tumors and Thoracic Outlet Pathology

Radiculopathy usually comes from foraminal stenosis or disc herniation, but tumors, infection, trauma, vascular and rheumatological causes can mimic it. Andy describes a C7 radiculopathy that slowly worsened despite good care and turned out to be a schwannoma. He refers when pain is severe, motor loss is marked or spans more than one nerve root, or a milder case fails to respond to conservative care. A Pancoast tumor of the lung apex makes up about 3 to 5% of lung cancers, and 96% present first with shoulder pain. Other features are C8 to T2 plexopathy symptoms, hoarseness and Horner syndrome, seen in about 25%, with ptosis, miosis and anhidrosis on one side. Smoking accounts for 71% of lung cancer. Arterial thoracic outlet syndrome, often linked to a cervical rib, causes claudication-type arm pain with coldness and pallor. Venous compression causes a hot, swollen, bluish arm with dilated superficial veins. Primary upper limb DVT, or Paget-Schroetter syndrome, affects young active people and can progress rapidly.