Thoracic Outlet Syndrome

Question 1

What is a syndrome

Answer 1

Symptoms that occur together or in a group

Question 2

Thoracic outlet syndrome (TOS)

Answer 2

Groups of symptoms resulting from compression/obstruction of structures in the thoracic outlet

Includes the following structures

• subclavian artery/vein
• branchial plexus
• scalenes

Question 3

Symptoms of TOS

Answer 3

Ischemia/ decreased pulses

Pallor

Coolness

Swelling

Pain

Paresthesia

Cyanosis

Question 4

Possible Differential diagnosis in TOS

Answer 4

Cervical disc herniation

Pa coast tumors

Carpal tunnel syndrome

Brain/spinal cord lesions

Somatic dysfunction of

• cervical spine
• thoracic spine
• ribs
• clavicles
• UE

Question 5

How to differentiate TOS from specific diagnoses

Answer 5

TOS = usually the whole hand/arm

Specific diagnoses = specific parts of the dermatomes of the cervical plexus

Question 6

Generalized TOS tests

Answer 6

Upper limb tension

Roos test

Question 7

Specific TOS tests

Answer 7

Wright test
- pec muscle entrapment

Adsons test
- scalene impingement

Halstead (reverse adsons)
- cervical rib impingement

Question 8

Double crush syndrome

Answer 8

Compression of two or more locations along the course of peripheral nerves (cause increased symptoms in an additive effect)

Question 9

Factors that predispose to TOS

Answer 9

Cervical ribs

Unusual sleeping position

Ectomorphic body habits

History of clavicular fractures

Members of military

Construction workers

Mechanics

Painters/artists

Question 10

What signs require further work up then just diagnosising and opening up TOS?

Answer 10

Unresponsive to any treatment

Unusual patterns that dont add up

Symptoms are bilateral

Loss of motor/ nerve function

Muscle wasting