Some of the diagnoses that should come to mind are mid-cervical radiculopathy, Thoracic Outlet Syndrome, nerve entrapment, Carpal Tunnel Syndrome, scapula dysfunction secondary to scoliosis.

Physical Exam Findings:

Weight: 120, Height: 5’4”

Adam’s position confirmed a tertiary levorotary scoliosis with rib cage distortions. Bilateral TMJ dysfunction with a right lateral shift; cervical rotary, lateral flexion and extension fixations from C1-7; thoracic spine lateral and rotary deviations to the right with fixations at the upper mid and lower thoracic spine. Patient has a significantly posteriorly protruded right rib cage.

The right scapula was elevated, retracted and riding over the top of the first rib bringing the glenohumeral joint anterior and superior as with shoulder rounding. Lumbar spine was laterally deviated and rotated to the left.

Spasms were noted in the right levator scapula, cervical extensors, upper trapezius, right biceps, right subscapularis, right pectoralis and coracobrachialis, left multifidus. Tinel’s Test and Phalen’s Test for Carpal Tunnel Syndrome were negative. Adson’s Maneuver, Costoclavicular Test and Wright’s Test were negative for Thoracic Outlet Syndrome.

Question: What is your working diagnosis at this point?