This group is the largest group of TOS presentations, and remains the most controversial (Rayan, 1998 Lee et al., 2006). Symptomatic TOS (sTOS): is associated with symptoms of TOS, however, there are no objective neurological, electro-physical or radiological abnormalities.True Neurological TOS (tnTOS): is associated with true neurological deficits (mostly muscular atrophy).Neurological TOS can be further divided into two groups, which are: Neurological Thoracic Outlet Syndrome (nTOS): represents approximately 97% of cases and compression is of the neural structures of the brachial plexus.Arterial TOS (aTOS): which involves compression of the subclavian or axillary artery and accounts for 1% of cases (Roos et al., 1987 Davidovic et al., 2003).Venous TOS (venTOS): which involves compression of the subclavian or axillary vein and accounts for 2% of cases.Vascular Thoracic Outlet Syndrome (vTOS): which represents approximately 3% of cases and compression is of the vascular structures. vTOS is generally easier to define, diagnose and treat than nTOS (Sharp et al., 2001).Therefore, thoracic outlet syndrome can be divided into 2 groups: In the sub-coracoid tunnel beneath the tendon of the pectoralis minor (removed in the image below) (Wright and Jennings, 2005).Ĭlassification of Thoracic Outlet SyndromeĪs suggested previously, there are different types of thoracic outlet syndrome which are based on the structures that are compressed.Beneath the clavicle in the costo-clavicular space, where the neural elements are already outside the thorax (clavicle is removed in the below image).However, this condition should technically be referred to as cervical outlet syndrome (Ranney, 1996). It is worth noting that the upper roots of the brachial plexus may also be compressed between the scalene muscles as they exit the cervical spine. This will result in compression of the lower roots of the brachial plexus. As they exit from the thoracic cavity and rise up over the first rib and pass between the anterior and middle scalene muscles. ![]() In fact, there are three possible sites of compression of the vessels and nerves. Quite obviously, this will result in a wide variety of symptoms dependent upon the structure that is compressed and the location of compression. The pain and discomfort of TOS are generally attributed to the compression of the This article will discuss the pathoanatomy, classifications, aetiology, assessment, diagnosis and management of thoracic outlet syndrome. “Thoracic outlet syndrome (TOS) is a symptom complex characterised by pain, paresthesia, weakness and discomfort in the upper limb which is aggravated by elevation of the arms or by exaggerated movements of the head and neck” (Lindgren and Oksala, 1995) Thoracic outlet syndrome is considered to be a collection of quite diverse syndromes rather than a single entity (Yanaka et al., 2004), and therefore, accurate diagnosis and enlightened treatment decisions can be very challenging. Most people recover.The condition discussed in this article, you will come to find, is quite complex and can be a battle for the physiotherapist and physical therapist. Medicines, physical therapy, and relaxation might help. ![]() Treatment depends on what caused your TOS. Repetitive arm and shoulder movements and activity, such as from playing certain sports.Poor posture that causes nerve compression.Doctors do nerve and imaging studies to diagnose it. It usually starts between 20 and 50 years of age. If a vein is compressed, your hand might be sensitive to cold, or turn pale or bluish. If a nerve is compressed, you may also feel weakness in your hand. You may feel burning, tingling, and numbness along your arm, hand, and fingers. The compression can happen between the muscles of your neck and shoulder or between the first rib and collarbone. ![]() It happens when the nerves or blood vessels just below your neck are compressed, or squeezed. Thoracic outlet syndrome (TOS) causes pain in the arm, shoulder, and neck.
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