Thoracic Outlet Syndrome and Brachial Plexopathy in PA Workers’ Comp

Thoracic Outlet Syndrome (TOS) and Brachial Plexopathy are two conditions we see representing injured workers in Pennsylvania.  These conditions were recently in the news in the Philadelphia area, with the report that Phillies pitcher Vince Velasquez underwent surgery for TOS in the previous offseason.  Indeed, it is not an uncommon injury for a professional baseball pitcher; our firm has represented a former major league pitcher with the condition (of course, we have represented many more types of injured workers with this condition than professional athletes!).

Both TOS and brachial plexopathy are sort of general terms, each regarding issues in the brachial plexus area (think of it like a big city train station, where it is many branches of nerves coming together rather than railroad tracks).  There are many forms of these conditions, making diagnosis difficult.  As we have mentioned previously on this blog, brachial plexopathy can be confused for conditions in the shoulder and/or neck of the injured worker.  This difficulty is also mentioned in the Medical FAQs on our website.  In the PA workers’ compensation system, we are often litigating to have TOS or brachial plexopathy accepted as part of the work injury (since such conditions are rarely, if ever, voluntarily accepted by the workers’ compensation insurance carrier).

Part of the problem in getting TOS or brachial plexopathy accepted as a work injury is the fact the conditions can be caused in various ways.  In fact, some occurrences are “idiopathic,” meaning that there is no known cause.  On the other hand, trauma is an established cause of the conditions.  It is also important to note that when we talk of “trauma” as a cause of TOS or brachial plexopathy in a work-related injury, we are speaking both of a single injury, as well as some type of repetitive motion kind of injury.  As we have discussed on this blog, repetitive motion injuries are just as much “work injuries” as single traumatic episodes.

Since there are different forms of this problem, and different variables with each patient, there is not a single standard treatment.  Some, like Velasquez, undergo a surgical procedure to address the issue directly.  Other treatment options could include medications, injections, physical therapy and the placement of a spinal cord stimulator.  In our blog, over the years, we have also tried to learn about any new, potential, treatments for TOS and brachial plexopathy.