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thoracic outlet syndrome

Introduction

  • thoracic outlet syndrome is an uncommon pathology where either nerves, artery, or veins to the arm or head are compressed after they leave the thoracic outlet

Aetiology

  • cervical rib
  • pectoralis minor syndromes
  • anterior scalene syndrome
  • costoclavicular syndrome
    • diagnosed with the costoclavicular maneuver
  • trauma

Clinical features

neurogenic TOS

  • 95% of cases of TOS
  • compression of brachial plexus nerves (C5-T1)
  • frequently occurs in those in their second to fourth decades of life
  • 70% of those affected being female
  • clinical features may include:
    • pain or aching in neck, shoulder, arm, or hand;
    • paresthesias in ulnar distribution
    • hand weakness, fatigue, or atrophy (e.g., thenar or intrinsic muscles)
    • headache is common due to secondary spasm of paraspinal and trapezius muscles
    • symptoms worsen with overhead activity (eg hanging clothes, brushing hair), poor posture or perhaps repetitive motions like walking
    • tenderness at the point of plexus compression:
      • the scalene triangle in the supraclavicular space, or,
      • at the pectoralis minor insertion site at the coracoid process
  • see also:

arterial TOS

  • 1% of cases

venous TOS

  • 4% of cases
  • painful, swollen and blue arm, particularly when occurring after strenuous physical activity
tos.txt · Last modified: 2026/01/06 10:18 by gary1

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