![]() ![]() Constant muscle tension in the shoulder girdle (carrying heavy loads)Ī. Repetitive positioning of arms overhead (shoulder elevation and hyperabduction)Į. Depressed and retracted clavicles (military posture)ĭ. Constant respiratory movement with respirationĪ. Subclavian artery may bifurcate one of scalenesĭ. Because TOS can stem from a variety of causes, a detailed patient evaluation is important.Ĭ. Middle-aged women with sagging shoulders or obese, full-figured women are more prone than others to develop TOS. It should be noted that the cervical ribs are present in less than 0.5 percent of the population and symptomatic in only 5 percent to 10 percent.3 Fibrous bands that extend between cervical vertebrae and the first rib may also be a source of compression. Women are generally more affected than men by the disorder. The neurovascular compression can result from a variety of causes (see Table). ![]() ![]() The subclavian vein travels the same course except it passes anterior to the anterior scalene muscle.Ĭompression sites generally include the interscalene triangle, costoclavicular space, or pectoralis minor muscle. The thoracic outlet is the triangular shaped channel through which the nerves and vessels of the arm leave the neck and thorax.3 The subclavian artery and brachial plexus arch over the first rib between the anterior and middle scalenes, then pass under the clavicle and subclavian muscle, then travel under the pectoralis minor muscle and into the axilla. Other clinical terms used to describe this presentation include the scalenus anticus, costoclavicular, hyperabduction, pectoralis minor and cervical rib syndromes. Symptoms will vary according to the severity of the compression. Symptoms of TOS may include upper extremity pain, paresthesias, numbness, muscle weakness, sensation of heaviness, discoloration, edema, arm fatigue, ulceration and gangrene. Thoracic outlet syndrome (TOS) is a collection of syndromes resulting from abnormal compression of the brachial plexus and/or the subclavian artery/vein (neurovascular bundle) that occurs between the cervical spine and the axilla. Tests can be effective in diagnosing this sometimes confounding condition Evaluation and Treatment for Thoracic Outlet Syndrome ![]()
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