Thoracic Outlet Syndrome

Question 1

What is TOS

Answer 1

Describes the compression of the neuromuscular structures as they exit through the thoracic outlet region. Thoracic outlet, is marked by the anterior scalene, medial scalene and first rib

Question 2

Epidemiology and risk factors of TOS

Answer 2

Anatomical variations (cervical rib, abnormal muscle development)
Trauma or injury to the neck or shoulder
Repetitive overload activities
Atheletes
Poor posture, particularly forward head posture
Obesity
20-50 year olds
More common in women to men, 3:1

Question 3

Clinical presentation of TOS

Answer 3

Pain in the neck, shoulder and arm
Numbness or tingling in the fingers
Weakness in the hands and arms
Symptoms that worsen with overhead activities or prolonged postures
Vascular symptoms such as swelling or discolouration of the arm
Swelling in the arm or hand
Cyanosis (bluish discolouration) of the arm or hand
Development of veins on the chest
Coldness/paleness in the hands/fingers
Weak or absent pulse
Pain or cramping in the arm during activity (radiating)

Question 4

Systemic effects of TOS

Answer 4

The systemic effects can vary based on the structures imvolved, neurological symptoms may include pain, numbness and weakness in the arms and hand, vascular involvement leads to symptoms such as coldness, paler and swelling in the affected limb. Chronic compression can results in muscle atrophy and functional impairment.
Aoso limits patients ability to perform daily tasks, taking a psychological toll

Question 5

Pathology of TOS

Answer 5

Includes the compression of the brachial plexus and the subclavian vessels. It can occur due to anatomical deformity such as an extra first rib, right fibrous walls or muscular . The compression can lead to ischeamic, neuropathy and pain.

Question 6

Different diagnosis of TOS

Answer 6

Cervical radiculopathy
Carpal tunnel syndrome
Peripheral neuropathy
Pancoast tumour (lung cancer at the apex of the lung)aneurysm of the subclavian artery
Complex regional pain syndrome

Question 7

Treatment of TOS

Answer 7

Physio therapy to improve posture and strengthening of shoulders
Pain management ent and medications NSAIDs and analgesic
Activity/lifetsyle modifications to avoid painful movements
Surgical options such as decompression surgery