A 21-year-old woman consulted due to right hand weakness, numbness, and tingling of two years’ duration. Her handwriting became different, and she dropped objects all the time. She had to use her left hand to do most tasks because her right hand had become so clumsy. On examination, she is a very thin person with a long neck. Muscle testing was normal except for hand weakness, as well as some muscle wasting in her right hand. There was numbness and tingling in all the fingers of her right hand. 

X-ray of the neck showed the presence of cervical ribs. Electrodiagnostic studies showed that the lower trunk of the brachial plexus was affected; hence, the patient was diagnosed to have thoracic outlet syndrome. 

Thoracic outlet syndrome is a condition wherein there is compression of the nerves and blood vessels as it passes through the thoracic outlet. The cause of the compression may be a cervical rib or fibrous bands. 

The patient underwent surgery to remove the cervical rib and the fibrous bands attached to it, so as to release the pressure on the brachial plexus. The surgery went well and the patient gradually improved over time.