Thoracic Outlet Syndrome
What is Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome (TOS) involves compression of neurovascular structures (brachial plexus, subclavian artery/vein) at the thoracic outlet, leading to arm pain, numbness, or circulatory issues.
- Compression of nerves or blood vessels
- Leads to shoulder, arm, or hand symptoms
Overview of the Condition
Common subtypes include neurogenic TOS (most common), venous TOS, and arterial TOS. It can be due to anatomical anomalies or repetitive overhead activities.
Symptoms
- Neck, shoulder, or arm pain
- Numbness or tingling in the hand/fingers
- Weak grip or hand discoloration (vascular TOS)
Causes
Anomalies like a cervical rib, tight fibrous bands, poor posture, or repetitive overhead motions can lead to compression in the scalene triangle or costoclavicular space.
Diagnosis
Clinical maneuvers (Adson’s, Roos test), imaging studies (X-ray for cervical rib), and vascular/nerve conduction tests help confirm TOS type.
Treatment Options
- Physical therapy focusing on posture and scalene muscle release
- NSAIDs or muscle relaxants
- Surgery (rib resection, scalenectomy) for severe or refractory cases
Conservative Management
Physical therapy is the mainstay, emphasizing stretching of tight muscles (scalenes, pectoralis minor) and improving scapular mechanics.
Rehabilitation Exercises
- Neck and shoulder stretching
- Postural re-education
- Scapular stabilizing exercises
Surgical Options
Involves decompression of the thoracic outlet, possibly removing a cervical rib or releasing tight fibrous bands.
Anatomy Overview
The thoracic outlet is bordered by the scalene muscles, first rib, and clavicle. Structures passing here can be compressed if space is reduced.
Affected Areas
- Brachial plexus (neurogenic TOS)
- Subclavian artery or vein (vascular TOS)
Frequently Asked Questions
| Question | Answer |
|---|---|
| Is TOS difficult to diagnose? | Yes, symptoms can mimic other conditions like cervical radiculopathy or carpal tunnel syndrome. |
| Does everyone need surgery? | No, most improve with physical therapy; surgery is for severe or persistent cases. |
Prevention Strategies
- Maintain good posture
- Avoid repetitive overhead motions
- Strengthen neck and scapular stabilizers