[Ischemia of the arm with finger necroses: differential carpal tunnel syndrome and thoracic outlet syndrome diagnosis].

Upper extremity ischemia with finger necrosis: carpal-tunnel syndrome or thoracic outlet syndrome? A 26-year-old male patient complained of pain paraesthesia in the right upper extremity while working with the arm elevated. After electrophysiological diagnosis of a carpal-tunnel-syndrome the patient received surgical treatment. Following this treatment he developed acral necrosis at the fingers. Additional diagnostic effort let to the diagnosis of a thoracic-outlet-syndrome due to a cervical rib. This case report and a review of the literature show that electrophysiological investigations alone can not differentiate the carpal-tunnel-syndrome from the thoracic-outlet-syndrome. Thus an operative release of a carpal-tunnel should not be performed until the arterial perfusion of the upper extremity has been judged.