Thoracic Outlet Syndrome Flashcards
What is thoracic outlet syndrome?
Compression of 1 or more of the neurovascular structures in the thoracic outlet
What structures are commonly affected?
Brachial plexus
Subclavian artery
Subclavian vein
Where is the thoracic outlet
Area between the neck/shoulder, top of the thorax and under the clavicle to the axilla
What are common causes of thoracic outlet syndrome?
Trauma
Repetitive movements
Cervical rib
What are risk factors for developing TOS?
Cervical rib Trauma Poor posture Repetitive overhead activity Obesity Female
What are the types of TOS?
Neurological TOS
Vascular TOS
What is neurological TOS?
Injury of the brachial plexus
What is vascular TOS?
Compression of the subclavian vein/artery
What are the symptoms of neurological TOS?
Painless hand muscle wasting
Numbness/tingling
Cold hands
Arm swelling
What are the symptoms of vascular TOS?
Diffuse arm swelling
Distended veins
Painful arm claudication
Ulceration
What investigations are used in suspected TOS?
Cervical spin x-ray
CXR
EMG/nerve conduction study - if neurological is suspected
CT angiography - if arterial suspected
Doppler ultrasonography - if venous is suspected
How is neurological TOS managed?
Surgery to manage nerve compression if present
Conservative management
How is arterial TOS managed?
Surgery - decompression
How is venous TOS managed?
Catheter-directed thrombolysis
