Thoracic Outlet Syndrome
What is it?
What is it?
- TOS involves the compression of the brachial plexus in their course from the cervical area toward the axilla and proximal arm, either at the interscalene triangle, the costoclavicular triangle, or the subcoracoid space
- Congenital factors:
- cervical rib
- fibrous muscular bands
- abnormalities of the insertion of the scalene muscles
- exostosis of the first rib
- cervicodorsal scoliosis
- congenital unilateral or bilateral elevated scapula
- Acquired conditions:
- Postural factors:
- slouched shoulders
- ergonomic posture (standing or sitting without paying attention to the physiological curvature of the spine)
- heavy chested women
- Trauma:
- clavicle/rib fractures
- whiplash
- Repetitive stress injuries (i.e. sitting at a computer)
- Muscular causes:
- hypertrophy of the scalene muscles
- decrease in tone of the trapezius, levator scapulae, or rhomboid muscles
- shortening of the scalene, trapezius, levator scapulae, or pectoral muscles
- history of neck trauma
- pain
- paresthesia
- weakness
- headaches
- nocturnal paresthesias that wake up the patient
- loss of fine motor skills
- signs and symptoms more at night than day
- Patients experience pain in the shoulder and arm.
- Adson’s maneuver
- Halsted maneuver
- Roos overhead exercise test
- Physical examination
- history
- provocative tests
- diagnostic modalities (radiography, electrodiagnostic tests, brachial plexus neurography, color Doppler sonography, computed tomography [CT], magnetic resonance imaging [MRI], digital subtraction angiography)
- paresthesia in upper extremity
- pain in the neck, trapezius, supraclavicular area, chest, and occiput
- upper plexus (C5,6,7) involvement
- pain in anterior neck from the clavicle up to and including the mandible, ear, and mastoid region
- symptoms can continue into the anterior chest, scapular region, trapezius and into lateral part of the arm continuing all the way to the thumb and index finger
- lower plexus (C8,T1) involvement
- symptoms along the medial side of the arm and hand with potential involvement in the anterior shoulder and axillary region