Thoracic Outlet Syndrome: A Primer on Objective Methods of Diagnosis

Abstract

Thoracic outlet syndrome (tos) is a disabling symptomatic condition that arises from injury to nerves of the brachial plexus and the subclavian vessels as these structures pass from the neck and thorax into the upper limb. 1 Sanders R. Thoracic outlet syndrome: a common sequela of neck injuries. JB Lippincott, Philadelphia1991 Google Scholar , 2 Atasoy E. Thoracic outlet compression syndrome. Orthop Clin N Am. 1996; 27: 265-303 PubMed Google Scholar , 3 Luoma A. Nelems B. Thoracic outlet syndrome: thoracic surgery perspective. Neurosurg Clin North Am. 1991; 2: 187-225 PubMed Google Scholar , 4 Heughan C. Thoracic outlet compression. Can J Surg. 1984; 24: 35-36 Google Scholar The condition usually presents with pain, fatigue, and deep muscle aching suggesting a nonspecific nocicentric type of injury signal. Neuropathic reports suggesting direct nerve injury may localize symptoms to the medial cord of the plexus or ulnar innervated area of the upper limb. Arterial insufficiency may produce overlapping chronic or acute symptoms such as ischemic pain in the limb, coldness, or blanching in the hand during exercise. A subclavian artery aneurysm may produce emboli and distal digital ischemia. 1 Sanders R. Thoracic outlet syndrome: a common sequela of neck injuries. JB Lippincott, Philadelphia1991 Google Scholar Venous obstruction may be associated with chronic swelling in the limb. Acute venous thrombosis may be experienced after vigorous exercise in patients with costoclavicular compression. 1 Sanders R. Thoracic outlet syndrome: a common sequela of neck injuries. JB Lippincott, Philadelphia1991 Google Scholar , 5 Machleder H.I. Evaluation of a new treatment strategy for treatment of Paget-Schroeder syndrome: spontaneous thrombosis of the subclavian vein. J Vasc Surg. 1993; 17: 305-317 Abstract Full Text Full Text PDF PubMed Scopus (223) Google Scholar •Discuss the different signs and symptoms between neurologic, arterial, and venous thoracic outlet syndrome. •Describe the Wright's and Adson’s tests. •Discuss the role of plain x-rays in the diagnosis of thoracic outlet syndrome. •Compare and contrast the various vascular imaging studies for thoracic outlet syndrome. •State the role of Botox in thoracic outlet syndrome. •Discuss the test of selective symptom provocation associated with oxygen saturation in the diagnostic algorithm of thoracic outlet syndrome. Earn up to 2 hours of CME credit per JHS issue when you read the related articles and take the online test. To pay the $20 fee and take this month's test, visit http://www.assh.org/professionals/jhs. •Discuss the different signs and symptoms between neurologic, arterial, and venous thoracic outlet syndrome. •Describe the Wright's and Adson’s tests. •Discuss the role of plain x-rays in the diagnosis of thoracic outlet syndrome. •Compare and contrast the various vascular imaging studies for thoracic outlet syndrome. •State the role of Botox in thoracic outlet syndrome. •Discuss the test of selective symptom provocation associated with oxygen saturation in the diagnostic algorithm of thoracic outlet syndrome. Earn up to 2 hours of CME credit per JHS issue when you read the related articles and take the online test. To pay the $20 fee and take this month's test, visit http://www.assh.org/professionals/jhs. Journal CME QuestionsJournal of Hand SurgeryVol. 35Issue 9Preview Full-Text PDF