Thoracic Outlet Syndrome Flashcards
What is thoracic outlet syndrome?
Syndrome occurring due to compression of the thoracic inlet resulting in symptoms due to pressure on the subclavian artery, vein and brachial plexus
What is the path of the subclavian artery and vein into the thoracic inlet?
Artery: From aorta over first rib into axilla and arm by running under the clavicle
Vein: Drains from axillary vein over first rib to join the internal jugular and brachiocephalic vein –> SVC
What are the types of thoracic outlet syndrome?
Venous- rarest
Arterial
Neurological
What are the symptoms of venous thoracic outlet syndrome?
Upper limb DVT- sudden onset swelling, dilated veins, blueish hand
Long term upper limb swelling
How do you manage venous thoracic outlet syndrome?
Conservative: Raise arm to reduce swelling over time
Medical: May thrombolyse to remove clot. Anticoagulate to prevent PE
Surgical: Cervical rib or first rib resection (if compression at rest or on abduction of arm)
What is the path of the brachial plexus into the thoracic inlet?
From cervical spine over top of first rib under clavicle
What are the symptoms of arterial thoracic outlet syndrome?
Occlusion and thrombosis
Embolisation (more common)–> Raynaud’s-like syndrome or embolic lesions affecting the hands
What are the symptoms of neurological thoracic outlet syndrome?
Pain/tingling sensation
Radiculopathy
May be in particular dermatome/nerve root
How do you investigate suspected thoracic outlet syndrome?
Duplex scan in normal position and with arms abducted and external rotation and abduction.
MRI, MRA, MRV- looking for extra cervical rib, band of tissue or if pressure is from first rib
Nerve conduction studies
How do you manage thoracic outlet syndrome?
Main principle is to prevent complications
Surgical: Resection of first rib, increase thoracic outlet volume
Who is most likely to get complications from thoracic outlet syndrome?
Especially venous type: Anyone with strong scalanus anterior --> crowding of thoracic inlet Butterfly swimmers Weight lifters Violinists Cellists
What is Adson’s test?
Disappearance of radial pulse on abduction and external rotation of the arm.
Suggestive of thoracic outlet obstruction
