thoracic outlet syndrome

Question 2

what is thoracic outlet syndrome

Answer 2

compression of brachial plexus, subclavian artery or vein at site of thoracic outlet

can be neurological or vascular

Question 3

aetiology of thoracic outlet syndrome

Answer 3

neck trauma when have anatomical predispositions - either acute / repeat trauma

eg cervical rib
scalene muscle hypertrophy and anamolous bands

Question 4

presentation of neurogenic TOS

Answer 4

painless muscle wasting of hand muscles - weakness
numbness
tingling
cold hands / blanching / swelling

Question 5

presentation of vascular TOS

Answer 5

subclavian vein compressions -> painful diffuse arm swelling with distended veins

subclavian artery compression -> painful arm claudication and ulceration and gangrene

Question 6

ix of TCS

Answer 6

CXR
spine XR
(check for bony abnormalities)
CT / MRI
venography / angiography
anterior scalene block confirm neurogenic TOS

Question 7

rx of thoracic outlet syndrome

Answer 7

conservative inc physio
surgical decompression if conservative has failed - early might prevent brachial plexus degeneration
botox