Improvement in Upper Limb and Systemic Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Symptoms After Surgical Treatment of Neurogenic Thoracic Outlet Syndrome.
Christoforou, Maritsa E, Lum, Ying Wei, Sroge, Sally C et al. · Cureus · 2025 · DOI
Quick Summary
This case study describes a 19-year-old woman with ME/CFS who also had a condition called thoracic outlet syndrome (TOS), where nerves in the upper chest become compressed. After surgery to relieve this compression on both sides of her body, she experienced not only relief from arm numbness and tingling, but also surprising improvements in migraines, brain fog, dizziness, and vision problems. This suggests that some ME/CFS patients might benefit from being evaluated for TOS, as treating it could potentially help with multiple symptoms.
Why It Matters
This case highlights a potential overlooked contributor to ME/CFS symptoms that might be surgically treatable. For patients with ME/CFS who have upper limb symptoms or hypermobility features, screening for TOS could identify a remediable cause of some symptoms. It also suggests that neurogenic compression syndromes warrant greater clinical attention in the ME/CFS population.
Observed Findings
A 19-year-old female with ME/CFS and hEDS developed progressive upper limb numbness and tingling unresponsive to 2 months of physical therapy.
Bilateral surgical treatment (rib resection, neurolysis, scalenectomy) resulted in complete resolution of upper limb paresthesias by 8 weeks post-operatively.
Following surgery, the patient reported complete resolution of migraines, occipital neuralgia, vertigo, and visual disturbances.
The patient experienced marked improvement in cognitive fogginess and lightheadedness after surgery.
Inferred Conclusions
Brachial plexus compression (TOS) may be underrecognized in patients with comorbid hEDS and ME/CFS and could contribute to both local and systemic symptoms.
Surgical treatment of TOS in this case led to resolution of upper limb compression symptoms and unexpected improvements in several systemic ME/CFS-associated symptoms.
Systematic screening for TOS and careful assessment of neurological symptoms should be considered in ME/CFS patients with hypermobility features.
Remaining Questions
How common is TOS in the broader ME/CFS population, particularly in those with hEDS?
Would other ME/CFS patients with similar TOS presentations experience comparable improvements in systemic symptoms after surgery?
What This Study Does Not Prove
This is a single case report and cannot prove that TOS is common in ME/CFS or that it causes ME/CFS symptoms broadly. It does not establish that surgery will help other ME/CFS patients with similar presentations. The improvement in systemic symptoms could reflect placebo effect, spontaneous improvement, or benefits specific to this individual's unique anatomy rather than a general TOS-ME/CFS relationship.
What is the mechanism by which brachial plexus decompression could improve systemic symptoms like cognitive dysfunction, vertigo, and visual disturbances?
Are there specific clinical criteria that could help identify which ME/CFS patients are most likely to benefit from TOS screening and surgical intervention?