Thoracic outlet syndrome Flashcards
What is thoracic outlet syndrome?
clinical features that arise from compression of the neurovascular bundle within the thoracic outlet
How can the signs and symptoms of thoracic outlet syndrome be split?
Neurological (95%), venous and arterial
What injuries does thoracic outlet syndrome usually occur?
hyperextension injuries, repetitive stress injuring, external compression like poor posture, anatomical abnormalities like a cervical rib or clavicle fracture
What are the risk factors for thoracic outlet syndrome?
recent trauma, repetitive motions, occupations, athletes, anatomical variants
What are the clinical features of thoracic outlet syndrome?
worsen with movement, compression of brachial plexus can cause paraesthesia, motor weakness, DVT, extreme swelling, claudication, acute limb ischaemia
What would be present on examination of thoracic outlet syndrome?
weakness, numbness, swelling, tenderness, limb ischaemia, tenderness over the scalene muscles
What are the three special tests for thoracic outlet syndrome?
Adsons manoeuvre, Roos test, Eleveys test
What is Adsons manoeuvre?
alpate the radial pulse on the affected side, with the arm initially abducted to 30 degrees. Ask the patient to turn their head and look at the affected side’s shoulder, before fully abducting, extending, and laterally rotating the shoulder. Any decrease or loss of pulse is suggestive of TOS.
What is Roos test?
Abduct and externally rotate the shoulder on the affected side to 90 degrees, bend the elbow to 90 degrees, then asking the patient to open and close the hands slowly over a 3-minute period. Worsening symptoms will develop if TOS is present.
What is Elvey’s test?
Extend the arm to 90 degrees, with the elbow extended and wrist dorsiflexed, then tilt the patients ear to each shoulder. A loss of the radial pulse or worsening symptoms is suggestive of TOS.
What investigations would be done for Thoracic outlet syndrome?
blood tests, chest X-ray to look for bony abnormalities, can do venous and arterial duplex ultrasound, CT imaging or venogram, nerve conduction studies
What is the initial management for thoracic outlet syndrome?
physiotherapy and weightless if neurogenic, botulinum toxin A injections, thrombolysis and anticoagulation if venous, if arterial with acute limb ischaemia will need stenting
What is the surgical management for Thoracic outlet syndrome?
decompression either supraclavicular or transaxillary, physiotherapy
What are the complications fo Thoracic outlet syndrome?
permanent nerve damage, aneurysmal dilation of the subclavian artery leading to embolisation, loss of limb function
