A woman with thoracic outlet syndrome and difficulty swallowing.

CLINICAL HISTORY A 44-year-old right-handed female deputy sheriff was rear ended in an auto accident while stopped at a traffic light. She had her seatbelt on at the time of impact. She experienced immediate pain in the back of her head and neck exiting her car unassisted. On the following day, she consulted with a chiropractor, who prescribed treatment for approximately 2 months, which helped temporarily. X-rays were obtained but not available for review. She was eventually evaluated by a rheumatologist, who referred her for magnetic resonance imaging (MRI) of her cervical spine. He advised her of the findings recommending further care. Two months later, she was evaluated by an orthopedist, who also obtained x-rays providing physical therapy for an additional 2 months. Epidural injections were recommended but not administered. An electromyogram was obtained, described as unremarkable. Because of increasing neck pain, numbness in her left face, and drooping of her left eyelid, she was referred to another orthopedist.