Thoracic Outlet Syndrome

 Causes 

    Cervical Rib

    Anomalous Scalenius Muscle 

    Types 

            1. Neurogenic - Upper Plexus Type 

                                    - Lower Plexus Type 

            2. Vascular 

https://my.clevelandclinic.org/health/diseases/17553-thoracic-outlet-syndrome-tos

    Sites of compression

        1. as plexus passes over first rib 

        2. under clavicle by subclavian tendon

        3. underneath the coracoid process 

    Provocative Tests 

     Adson , Wright, Roos 

    Investigations 

         Plain radiographs of chest and C-spine

         CT - for suspected bone anomaly 

         MRI - cervical pathology ,tumor or radiation plexitis 

         Doppler arteriography / venography

          EMG/ NCS 

    Treatment 

          Physiotherapy 

          Ist Rib resection , release or excision of scalene anterior and middle muscles (approach-                         transaxillary or supraclavciular )

          venous thrombolysis or arterial thrombectomy and vascular reconstruction