Although it is generally accepted that tos is caused by compression of brachial plexus elements or subclavian vessels in their passage from the cervical area toward the axilla and proximal arm, there is a great deal of disagreement among clinicians regarding its diagnostic criteria and. This can happen when there is an extra cervical rib or because of a tight fibrous band. The term thoracic outlet syndrome describes compression of the neurovascular structures as they exit through the thoracic outlet cervicothoracobrachial region. Thoracic outlet compression syndrome tocs is a complex of signs and symptoms caused by compression of neurovascular structures in the cervico brachial.
Thoracic outlet syndrome symptoms and causes mayo clinic. Symptoms of tos are directly related to the structures disrupted. Thoracic outlet syndrome might be caused by injury, overuse of your arm or poor posture. As a matter of fact, tos represents a spectrum of disorders encompassing at least four related syndromes. Shoulder or arm pain weakness paresthesias claudication raynauds phenomenon ischemic tissue loss gangrene. The thoracic outlet extends from the cervical spine and superior border of the mediastinum to the lateral border of the pectoralis minor muscle.
The correct diagnosis of thoracic outlet syndrome is critical as it can lead to chronic pain and limb dysfunction. Thoracic outlet syndrome defined as the symptomatic compression of the neurovascular bundle at the thoracic outlet venous, arterial, and neurogenic anatomy is the key to understanding thoracic outlet syndrome true incidence unknown 0. Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib thoracic outlet are compressed. Pdf throughout the years complexes of symptoms of the upper extremity, caused by compression, were to be explained. This anatomical variant of thoracic outlet syndrome is rare but can be differentiated from neurogenic thoracic outlet syndrome by symptoms and physical exam, especially tenderness found in the axillary area. Anatomy, symptoms, diagnostic evaluation and surgical treatment prof. Anatomy of the thoracic outlet and related structures. Some typical symptoms are arm or hand pain, numbness and weakness. Thoracic outlet syndrome tos is the constellation of symptoms caused by compression of neurovascular structures at the superior aperture of the thorax, properly the thoracic inlet.
Sep 28, 2009 thoracic outlet syndrome tos is a clinical phenomenon resulting from compression of the neurovascular structures at the superior aperture of the thorax which presents with varying symptoms. The first step in understanding thorax anatomy is to find out its boundaries. The diagnosis and treatment of patients with thoracic outlet syndrome has been. Reporting standards of the society for vascular surgery. The thoracic, or chest wall, consists of a skeletal framework, fascia, muscles, and neurovasculature all connected together to form a strong and protective yet flexible cage the thorax has two major openings. Thoracic outlet syndrome tos is a group of symptoms that occur when blood vessels or nerves in the space between your collarbone and your first rib thoracic outlet are squeezed. Knowledge of anatomy is the key to understanding the thoracic outlet syndrome tos. This narrowing can be seen in symptomatic and asymptomatic patients and plays a role in development of neurovascular compression in patients with tos 4 8 fig 1. Thoracic outlet syndrome tos is an umbrella term that describes three related syndromes caused by nerve compression in the upper body, specifically the nerves in the neck, chest and arms. Any anatomical anomaly in the thoracic outlet has the potential to predispose a patient to tos. In all types of tos, the thoracic outlet space is narrowed, and there is scar formation around the structures. Many important anatomical structures pass from the neck into the thorax and chest cavity from the thoracic outlet. Thoracic outlet syndrome tos is a condition arising from compression of the subclavian vessels andor brachial plexus as the structures travel from the. The thorax is the area of the body situated between the neck and the abdomen.
Neurogenic thoracic outlet syndrome is the most common manifestation, presenting with pain, numbness, tingling. Structures and spaces thoracic outlet syndrome center. The art of caring in the treatment of thoracic outlet syndrome. By definition, tos is hand and arm symptoms of pain, paresthesia, and weakness due to compression of the neurovascular bundle in the thoracic outlet area. Tos consists of a myriad of symptoms depending on compression of the neurovascular bundle of the upper limb as it passes through the thoracic outlet 11, 18, 22. Thoracic outlet syndrome tos is a condition in which there is compression of the nerves, arteries, or veins in the passageway from the lower neck to the armpit. The term thoracic outlet syndrome is used to describe a condition of compression of the nerves andor blood vessels in the region around the neck and collarbone, called the thoracic outlet. Thoracic outlet syndrome tos a collection of symptoms brought about by abnormal compression of the neurovascular bundle by bony, ligamentous or muscular obstacles in the narrow space between clavicle and 1 st rib. The anatomy of the thoracic outlet is dynamic, with abduction of the ipsilateral arm potentially resulting in narrowing of the thoracic outlet at all three spaces. Learn more about thoracic outlet syndrome and find out if your shoulder pain or collarbone pain is because of tos.
Anatomy, symptoms, diagnostic evaluation and surgical treatment 1. The term thoracic outlet is the area between the neck and shoulder, over the top of the thorax, and under the clavicle. Signs and symptoms in the patient are produced according to the structures involved, i. The thoracic outlet or inferior thoracic aperture is much larger than the thoracic inlet superior thoracic aperture the thoracic outlet is bounded by. Its rare but more serious when it affects a vein or an artery. Anatomy of the thoracic outlet and the thoracic outlet. Thoracic outlet syndrome is very controversial in the medical literature. Jun 03, 2018 thoracic outlet syndrome tos is an umbrella term that describes three related syndromes caused by nerve compression in the upper body, specifically the nerves in the neck, chest and arms. Each of these three are separate entities, though they can coexist and possibly. The thorax itself can be split up into various areas that contain important structures the thorax is bound by bony structures including the 12 pairs of ribs and thoracic vertebrae, whilst also being supported by many ligaments and muscles. Knowledge of thoracic outlet anatomy and the four major areas of compression is cardinal for the surgeon to perform thoracic outlet syndrome decompression without injuring major structures, having a minimal number of complications, and avoiding malpractice litigation. Thoracic outlet syndrome tos is a frequently overlooked peripheral nerve compression that creates difficulties for the clinician regarding diagnosis and management. Anatomy of the thoracic outlet and the thoracic outlet syndrome.
The purpose of this study was therefore to analyze the different. Common causes of thoracic outlet syndrome include physical trauma from a car accident. This can happen when there is an extra cervical rib or because of a tight fibrous band that connects the spinal vertebra to the rib. Thoracic outlet syndrome tos is a clinical phenomenon resulting from compression of the neurovascular structures at the superior aperture of the thorax which presents with varying symptoms. Thoracic outlet syndrome tos is a condition estimated to affect as many as 80 of every patients in the us alone. Thoracic outlet syndrome most commonly affects the nerves, but the condition can also affect the veins and arteries least common type. Sep 12, 2019 thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib thoracic outlet are compressed. Jul 15, 2019 thoracic outlet syndrome is caused by the compression of the neurovascular structures at the thoracic outlet, especially those passing through the interscalene triangle. Pdf on feb 1, 1987, t troeng and others published the anatomy of the thoracic outlet and the causes of thoracic outlet syndrome find, read and cite all the. The term thoracic outlet syndrome tos was introduced by peet et al. Thoracic outlet syndrome in a throwing athlete diagnosed with mri and mra. The washington university center for thoracic outlet syndrome at barnesjewish hospital promotes understanding of the basic anatomy of the thoracic outlet among patients. The neurogenic type is the most common and presents with pain, weakness, and occasionally loss of muscle at the base of. While estimates vary widely based in part on lack of consensus as to the definition of the syndrome, as many as 3000 first rib resections are performed annually in the us.
The term thoracic outlet refers to the area between the neck and shoulder, over the top of the thorax and under the clavicle. As a result, patients experience the symptoms of tos. Thoracic outlet syndrome tos is a group of disorders all having in common compression at the thoracic outlet. Surgical treatment of thoracic outlet syndrome in young.
Learn more about thoracic outlet syndrome and find. Lss anatomy of the thorax alexandra burkesmith topography of. A pectoralis minor block can be used similarly to an anterior scalene block to make the diagnosis. The thoracic outlet is the lower opening of the thoracic cavity whose edges are the lowest ribs. Thoracic outlet syndrome disorders differ, depending on the parts of the body they affect. The purpose of this report is to describe the normal mr anatomy of the thoracic outlet and its modification after postural maneuvers using an anatomicmr. Thoracic outlet syndrome neurosurgery oxford academic. Acquired changes in anatomy below the skin in the lower neck is a thick layer of fatty tissue called the scalene fat pad, which helps to protect the deeper muscular and neurovascular structures of the thoracic outlet. The neurogenic type is the most common and presents with pain, weakness, and occasionally loss of muscle at the base of the thumb. The thorax itself can be split up into various areas that contain important structures the thorax is bound by bony structures including the 12 pairs of ribs and thoracic vertebrae, whilst also being supported by many ligaments and muscles the muscles of the thorax are also important for the vital actions of.
The thoracic outlet or inferior thoracic aperture is much larger than the thoracic inlet superior thoracic aperture. The purpose of this study was therefore to analyze the different clinical. Thoracic outlet syndrome tos is controversial in terms of definition, anatomy, aetiology and. Anatomy of interscalene triangle and its role in thoracic outlet. Review article thoracic outlet syndrome abstract thoracic outlet syndrome is a welldescribed disorder caused by thoracic outlet compression of the brachial plexus andor the subclavian vessels. About 95% of thoracic outlet syndrome cases involve nerves. Although it is generally accepted that tos is caused by compression of brachial plexus elements or subclavian vessels in their passage from the cervical area toward the axilla and proximal arm, there is a great deal of disagreement among clinicians regarding its diagnostic criteria and optimal. The thoracic outlet is bounded by the bony structures of the spinal column, first ribs, and sternum.
Anatomy of the thoracic outlet, demonstrating subclavian artery, vein and brachial plexus passing between the clavicle and first rib. Thoracic outlet syndrome tos is one of the most controversial clinical entities in medicine. The thoracic outlet is an anatomical area in the lower neck defined as a group. Pdf the anatomy of the thoracic outlet and the causes of thoracic. Anatomy of the thoracic outlet and the thoracic outlet syndrome see online here the superior thoracic aperture, or thoracic outlet, is an upper chest area located below the clavicles and between the neck and the shoulders. Below the skin in the lower neck is a thick layer of fatty tissue called the scalene fat pad, which helps to protect the deeper muscular and neurovascular structures of the thoracic outlet the presence of the scalene fat pad also makes it difficult to feel the structures of the thoracic outlet when pressing with the fingers on the lower neck.
The diagnosis of thoracic outlet syndrome is often missed even by experienced doctors. An anatomical redefinition that makes clinical sense. The thoracic, or chest wall, consists of a skeletal framework, fascia, muscles, and neurovasculature all connected together to form a strong and protective yet flexible cage. Reporting standards of the society for vascular surgery for.
Regarding to the varying symptoms, the diagnosis of tos seems to be a challenge and predictors for the outcome are rare. Thoracic outlet syndrome is a rare condition that occurs when there is compression of vessels and nerves in the area of the clavicle. This weakens the blood circulation in the neck, shoulder and arm. It is closed by the diaphragm, which separates the thoracic cavity from the abdominal cavity. This helps them comprehend how the compression of nerves, arteries, veins, and blood vessels in this area affects an individuals health and wellbeing and can lead to tos. Thoracic outlet syndrome is caused by the compression of the neurovascular structures at the thoracic outlet, especially those passing through the interscalene triangle.
Povilas pauliukas the thoracic outlet is called the space through which the neurovascular bundle. The thoracic outlet is marked by the anterior scalene muscle anteriorly, the middle scalene posteriorly, and the first rib inferiorly. Imaging of the patient with thoracic outlet syndrome. Congenital anomalies associated with thoracic outlet syndrome. Esposito md, arrington ja, blackshear mn, murtagh fr, silbiger ml. Thoracic outlet syndrome, a group of diverse disorders, is a.
Anatomy of the thoracic outlet understanding the anatomy and compartments of the thoracic outlet is essential for accurate reporting of the location of disease. The syndrome is classified on the basis of the structures involved. This can cause pain in your shoulders and neck and numbness in your fingers. While the anatomy of the thoracic outlet is complex, understanding the anatomy enables understanding of tos. One of the reasons is that the symptoms can look a lot like other problems, such as muscle strain. Thoracic outlet syndrome refers to a group of conditions that develop when the blood vessels or nerves in the thoracic outlet become compressed.
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