Abstract
Thoracic outlet syndrome (TOS) describes a group of disorders that are due to a dynamic compression of blood vessels or nerves, between the clavicle and first rib or cervical vertebral nerve roots. Individuals with TOS typically experience upper limb pain, numbness, tingling, or weakness that is exacerbated by shoulder or neck movement. The causes of TOS vary, and can include abrupt movements, hypertrophy of the neck musculature, and anatomical variations in which the brachial plexus roots pass through this musculature, edema, pregnancy, repeated overhead motions, the blockage of an artery or vein, or abnormal posture. To understand the complexity of this condition, an analysis of shoulder anatomy and mechanics are needed to help describe limitations and the subsequent pathophysiology of TOS. Several treatment options are available, including surgery, medications, and exercise. A comprehensive study of shoulder anatomy and biomechanics, and knowledge of the benefits of exercise, may help clinicians and healthcare practitioners determine the most appropriate treatment plan for an individual with TOS.
Highlights
Thoracic outlet syndrome (TOS) is defined as the compression of nerves or blood vessels near the base of the neck [1]
It is important to understand the functional anatomy of the shoulder, how the shoulder affects TOS, and how rehabilitation efforts focused on shoulder and back musculature can provide a conservative treatment plan
The most critical muscles that influence shoulder motion and stability are the rotator cuff muscles. This muscle group is responsible for maintaining the humeral head in the appropriate position and providing the necessary torque produced from agonist and antagonist coactivations [28,32]
Summary
Thoracic outlet syndrome (TOS) is defined as the compression of nerves or blood vessels near the base of the neck [1]. The condition is caused by the presence of a cervical rib or bony growth near a nerve root in the neck [2,9,10,11,12,13] This abnormality may alter the attachment site of the scalenes, which may further complicate vTOS [1,5,6,10,14,15]. The sternocleidomastoid and scalenes shorten, which can alter the function of these muscles [22] This can lead to an entrapment of the brachial plexus, subclavian artery, subclavian vein, or a combination of these vessels and tissues [2,19]. It is important to understand the functional anatomy of the shoulder, how the shoulder affects TOS, and how rehabilitation efforts focused on shoulder and back musculature can provide a conservative treatment plan
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