III. Symptoms

  1. Neural Involvement (95%)
    1. Ulnar Nerve is the most commonly affected structure
    2. Extremity pain
    3. Extremity numbness
  2. Venous Involvement (4%)
    1. Distal extremity swelling
  3. Arterial Involvement (1%)
    1. Extremity falls asleep
    2. Glove distribution with or without paresis

VI. Management: Conservative (Physical Therapy)

  1. See specific conditions
  2. Elevate Shoulder
    1. Rest on arm of chair
    2. Sling
  3. Pendulum Shoulder Exercises
  4. Moist heat and Ultrasound
  5. Strengthening Exercises for Shoulder girdle Muscles
    1. Trapezius Muscle
      1. Shoulder shrug with weight
    2. Serratus anterior
      1. Bench Press, lifting Shoulders from table
  6. Correct faulty Posture
  7. Avoid positions that exacerbate symptoms

VII. Management: Surgery

  1. Indications
    1. Vascular compromise (rare)
    2. Conservative management fails after 4-6 months
  2. Surgery (Consider after conservative Rx fails x4-6mo)
    1. Removal of first dorsal and cervical ribs
    2. Release of abnormal scalene Muscle insertions
    3. Vascular repair

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Related Studies

Ontology: Thoracic Outlet Syndrome (C0039984)

Definition (MSH) A neurovascular syndrome associated with compression of the BRACHIAL PLEXUS; SUBCLAVIAN ARTERY; and SUBCLAVIAN VEIN at the superior thoracic outlet. This may result from a variety of anomalies such as a CERVICAL RIB, anomalous fascial bands, and abnormalities of the origin or insertion of the anterior or medial scalene muscles. Clinical features may include pain in the shoulder and neck region which radiates into the arm, PARESIS or PARALYSIS of brachial plexus innervated muscles, PARESTHESIA, loss of sensation, reduction of arterial pulses in the affected extremity, ISCHEMIA, and EDEMA. (Adams et al., Principles of Neurology, 6th ed, pp214-5).
Definition (MEDLINEPLUS)

Thoracic outlet syndrome (TOS) causes pain in the arm, shoulder, and neck. It happens when the nerves or blood vessels just below your neck are compressed, or squeezed. The compression can happen between the muscles of your neck and shoulder or between the first rib and collarbone. You may feel burning, tingling, and numbness along your arm, hand, and fingers. If a nerve is compressed, you may also feel weakness in your hand. If a vein is compressed, your hand might be sensitive to cold, or turn pale or bluish. Your arm might swell and tire easily.

TOS is more common in women. It usually starts between 20 and 50 years of age. Doctors do nerve and imaging studies to diagnose it.

There are many causes of TOS, including

  • Injury
  • Anatomical defects
  • Tumors that press on nerves
  • Poor posture that causes nerve compression
  • Pregnancy
  • Repetitive arm and shoulder movements and activity, such as from playing certain sports

Treatment depends on what caused your TOS. Medicines, physical therapy, and relaxation might help. Surgery may also be an option. Most people recover.

NIH: National Institute of Neurological Disorders and Stroke

Definition (NCI) A syndrome resulting from the compression of the blood vessels or nerves in the space between the clavicle and first rib (thoracic outlet). It is caused by car accident injuries or repetitive job or sport-related injuries. Signs and symptoms include pain in the shoulders and neck, numbness in the fingers, and weakening grip.
Concepts Disease or Syndrome (T047)
MSH D013901
ICD10 G54.0
SnomedCT 2040007, 393578000, 193106006, 212769008, 193108007, 193107002, 128210009
English Syndromes, Thoracic Outlet, Thoracic Outlet Syndromes, Syndrome, Thoracic Outlet, thoracic outlet syndrome (diagnosis), thoracic outlet syndrome, Aperture Syndrome, Thoracic Outlet, Superior Thoracic Aperture Syndrome, Neurovascular Syndrome, Thoracic Outlet, Thoracic Outlet Neurovascular Syndrome, Outlet Syndrome, Thoracic, Outlet Syndromes, Thoracic, Thoracic Outlet Syndrome [Disease/Finding], outlet syndromes thoracic, thoracic outlet syndromes, outlet syndrome thoracic, TOS, Thoracic Outlet Syndrome, Thoracic outlet syndrome, TOS - Thoracic outlet syndrome, Thoracic outlet syndrome (disorder), cervicothoracic outlet; syndrome, outlet; thoracic, syndrome, syndrome; cervicothoracic outlet, syndrome; thoracic outlet, thoracic outlet; syndrome, Thoracic outlet syndrome [Ambiguous]
Swedish Toraxapertursyndrom
Japanese キョウカクデグチショウコウグン, 胸郭口症候群(キョウカクグチショウコウグン), 胸郭口症候群, 胸郭出口症候群(キョウカクデグチショウコウグン), 前斜角筋症候群, 肋鎖症候群, 斜角筋症候群, Thoracic Outlet症候群, 胸郭出口症候群
Czech syndrom horní hrudní apertury, Syndrom horní hrudní apertury, syndrom horní apertury
Finnish Thoracic outlet -oireyhtymä
Italian Sindrome dello sbocco toracico, Sindrome dello stretto toracico superiore, TOS, Sindrome dell'egresso toracico da compressione neurovascolare, Sindrome dell'egresso toracico, Sindrome da ostruzione toracica, Sindrome dell'outlet toracico
Polish Zespół wylotu klatki piersiowej, Zespół ujścia klatki piersiowej, Zespół ciasnoty górnego otworu klatki piersiowej, Zespół uciskowy górnego otworu klatki piersiowej, Zespół górnego otworu klatki piersiowej
Hungarian Thoracic outlet syndroma
Norwegian Thorax outlet syndrome, Thoraxutløpssyndromet, Thoraxapertursyndromet, Toraksutløpssyndromet
Spanish Síndrome de la Salida del Tórax, Síndrome de la Salida Torácica, Síndrome del Orificio de Salida Torácico, Síndrome de Salida Torácica, Síndrome de Salida del Tórax, síndrome de compresión torácica (trastorno), síndrome de compresión torácica, síndrome del opérculo torácico, Síndrome del estrecho torácico, Síndrome del Desfiladero Torácico, Síndrome Neurovascular Torácico Exterior
Portuguese Síndrome de Saída do Tórax, Síndrome da Saída Torácica, Síndrome de Saída Torácica, Síndrome da Saída do Tórax, Síndrome de saída torácica, Síndrome do Desfiladeiro Torácico, Síndrome Neurovascular da Saída do Tórax
Dutch cervicothoracic outlet; syndroom, outlet; thoracic, syndrome, syndroom; cervicothoracic outlet, syndroom; thoracic outlet, thoracic outlet; syndroom, thoracic outlet syndroom, Neurovasculair syndroom, thoracic outlet, Syndrome, thoracic outlet, Thoracic outlet syndrome
French Syndrome des défilés cervico-axillaires, Syndrome de traversée thoraco-cervico-brachiale, Syndrome du défilé cervico-thoraco-axillaire, Syndrome du défilé thoraco-brachial, Syndrome du défilé thoracobrachial
German Thoracic-Outlet-Syndrome, Thoracic-outlet-Syndrom, Neurovaskuläres Syndrom, Thoracic outlet, Thorakales Engpaß-Syndrom