Thoracic Outlet Syndromes

Question 1

What are thoracic outlet syndromes?

Answer 1

Group of disorders characterised by pain and paraesthesias in a hand, the neck, shoulder or an arm. Involved compression of brachial plexus (+/- subclavian vessels) as structures traverse thoracic outlet

Question 2

Pathogenesis of thoracic outlet syndromes?

Answer 2

• Compression of lower trunk of brachial plexus
• usually as they traverse thoracic outlet below scalene muscles and over 1st rib
• before they enter axilla
• compression may be due to: cervical rib, abnormal 1st thoracic rib, abnormal insertion/ position of scalenes, malunited clavicle fracture

Question 3

Which group is more common to have thoracic outlet syndromes?

Answer 3

Women, 35-55

Question 4

Symptoms and signs of thoracic outlet syndrome?

Answer 4

• Pain and paraesthesia beginning in neck or shoulder
• extends to medial aspect of arm and hand
• sometimes anterior chest wall
• mild-mod sensory impairment C8-T1
• +/- vascular autonomic changes

Question 5

When should thoracic outlet syndromes be considered?

Answer 5

Unexplained pain and parenthesis beginning in neck or shoulder and extending down medial arm.

Question 6

How should TOSs be investigated?

Answer 6

• Electrodiagnostic tests

- MRI brachial plexus +/- C spine

Question 7

Mx TOSs?

Answer 7

• PT

- Analgesics

Question 8

When should surgery be considered in TOSs?

Answer 8

-Cervical rib
-Subclavian artery compression
-Neurovascular deficits
Progressing despite conservative Mx