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
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