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Thoracic outlet syndrome (TOS) is a condition that arises from the compression of nerves or blood vessels in the lower neck and upper chest. The compression can be caused by tight muscles, poor posture, or structural issues such as an extra rib, a tumor, or an injury. Symptoms of TOS include pain, numbness, and tingling, which are often exacerbated by arm and neck movements. Treatment options include physical therapy, injections, and in severe cases, surgery to cut muscles or remove any structural obstructions.
| Characteristics | Values |
|---|---|
| Definition | Compression of nerves or blood vessels in the lower neck and upper chest |
| Anatomical Term | Thoracic outlet/ inlet/ superior thoracic aperture |
| Structures Involved | Brachial plexus, subclavian artery, subclavian vein |
| Bordered By | Anterior scalene muscle, middle scalene, first rib |
| Symptoms | Pain in the neck, chest, and arm, abnormal sensations (paresthesia), vague pain, atrophy of intrinsic muscles of the hand, weakness, neurological sensory deficits |
| Risk Factors | Anatomical variations, injuries, whiplash, bodybuilding, repeated overhead motions, weight gain, tumors, trapezius muscle deficiency, clavicle fractures, congenital abnormalities, cervical ribs, abnormal muscle formation |
| Diagnosis | Electrodiagnostic testing, nerve conduction velocity (NCV), electromyography (EMG), duplex ultrasound, neurological examination, Roos stress test, chest X-ray |
| Treatment | Physical therapy, pain medications, surgery, injections, thrombolytic therapy |
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What You'll Learn
- The scalene muscles in the neck are sometimes surgically removed to treat TOS
- TOS occurs when muscles in the upper chest compress nerves or blood vessels
- Symptoms of TOS include pain, numbness, and tingling in the neck, chest, and arm
- TOS is caused by various anatomical abnormalities, such as fibrous muscular bands
- TOS is more prevalent in those with poor muscle development and poor posture
The scalene muscles in the neck are sometimes surgically removed to treat TOS
Thoracic outlet syndrome (TOS) is a group of disorders that occur due to the compression of nerves or blood vessels in the lower neck and upper chest. This compression can cause pain, abnormal sensations and other symptoms in the upper body. The scalene muscles in the neck are sometimes surgically removed to treat TOS.
The scalene muscles are a group of three pairs of muscles, with one set located on each side of the body. They are considered accessory breathing muscles, helping to open space for the lungs to expand in the thorax by lifting the top ribs. They also support the upright posture of the cervical spine, which is the upper part of the spine. The scalene muscles can be affected by a whiplash injury, especially when the trauma is on the side of the neck.
In the context of TOS, the scalene muscles can contribute to the compression of nerves and blood vessels. The thoracic outlet is bordered anteriorly by the anterior scalene muscle, posteriorly by the middle scalene, and inferiorly by the first rib. This area serves as a passageway for nerves and blood vessels travelling from the neck to the arm. When the scalene muscles are tight or tense, they can compress the brachial plexus nerve complex branches that pass through the scalene triangle.
Surgery for TOS involves removing one or more structures responsible for the compression of the brachial plexus nerve roots at the level of the scalene triangle. This includes the removal of the scalene muscles in the neck, specifically the anterior and middle scalene. The decision to perform surgery depends on the specific type of TOS, the patient's symptoms, and whether conservative treatments such as physical therapy and pain medications have been effective.
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TOS occurs when muscles in the upper chest compress nerves or blood vessels
Thoracic outlet syndrome (TOS) occurs when muscles in the upper chest compress nerves or blood vessels. This compression can cause pain, abnormal sensations (paresthesia), and other symptoms in the upper body. The thoracic outlet is an anatomical term referring to the opening between the neck and chest, a passageway for important structures such as the brachial plexus, subclavian artery, and subclavian vein.
TOS is a group of disorders caused by the compression of nerves or blood vessels in the lower neck and upper chest. This compression can occur due to anatomical variations, such as the presence of a scalene minimus muscle, or injuries that narrow the thoracic outlet. The scalene muscles, including the anterior and middle scalenes, can contribute to this compression.
The symptoms of TOS depend on the specific type, which includes neurogenic, venous, and arterial variants. Neurogenic TOS, the most common type, involves compression of the brachial plexus, resulting in vague pain, atrophy of hand muscles, and weakness. Venous TOS leads to upper body thrombosis, while arterial TOS involves the compression of an artery.
Diagnosing TOS can be challenging due to its complex presentation and vague symptoms. Electrodiagnostic testing, imaging, and neurological examinations are crucial for an accurate diagnosis. Treatment options vary depending on the type of TOS and its symptoms, ranging from physical therapy and pain medications to surgery in severe cases.
It is important to distinguish TOS pain from conditions like angina, heart attack, or stroke, as they share some similar symptoms but require immediate medical attention.
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Symptoms of TOS include pain, numbness, and tingling in the neck, chest, and arm
Thoracic outlet syndrome (TOS) is a rare disorder that affects people of all ages and genders, though it is more common in women and people between the ages of 20 and 50. TOS is caused by compression of the nerves, veins, or arteries in the thoracic outlet, which is the space between the lower neck and upper chest or the space between the collarbone and first rib. This compression can be caused by various factors, including anatomical variations, injuries, or muscles pressing on the nerves and blood vessels in this space.
The specific symptoms of TOS can vary depending on the type of TOS and the structures being compressed. Neurogenic TOS, which accounts for over 90% of cases, occurs when the brachial plexus nerve is compressed, leading to problems with sensation and movement in the shoulder, arm, hand, or fingers. Venous TOS, which accounts for 3-5% of cases, involves compression of the subclavian vein, resulting in arm swelling, pain, and an increased risk of blood clots. Arterial TOS occurs when the subclavian artery is compressed, leading to reduced blood flow to the arm and hand, causing pain and numbness.
Diagnosing TOS typically involves a medical history review, a physical examination, and diagnostic tests such as imaging or nerve conduction studies. Treatment options for TOS include conservative measures such as physical therapy, lifestyle changes, and medications, as well as more invasive options like surgery, in cases where conservative treatments are ineffective or if TOS interferes with normal blood flow.
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TOS is caused by various anatomical abnormalities, such as fibrous muscular bands
Thoracic outlet syndrome (TOS) is a group of disorders that occur due to compression of nerves or blood vessels in the lower neck and upper chest. This compression can cause pain, abnormal sensations (paresthesia) and other symptoms in the upper body. TOS is considered one of the most controversial topics in musculoskeletal medicine and rehabilitation due to its complex presentation and challenges in diagnosis.
TOS is caused by various anatomical abnormalities that increase pressure in the thoracic outlet region. One of the most common causes is cervical ribs, which are extra ribs that typically arise from the seventh cervical vertebrae. Other anatomical abnormalities include space-occupying lesions, such as tumours or cysts, and fibrous muscular bands from overuse or in muscular athletes.
Fibrous muscular bands are a common anatomical abnormality associated with TOS. These bands can increase pressure in the thoracic outlet, leading to neurologic irritation or compression of the brachial plexus. Studies have found that most patients with TOS have anomalous fibrous muscular bands near the brachial plexus, and these bands have been linked to neurological complaints in 99% of patients examined.
In addition to fibrous muscular bands, other muscular anomalies can contribute to TOS. These include a broad scalene attachment, hypertrophied scalenes, and muscular imbalances. Physical therapy is often recommended as a first-line treatment for TOS, as it aims to strengthen the muscles around the thoracic outlet to relieve pressure on the affected structures.
Diagnosing TOS can be challenging, and it is often identified through a combination of clinical assessment, imaging, and the exclusion of other potential causes. Electrodiagnostic testing and imaging, such as nerve conduction velocity (NCV) and electromyography (EMG), are useful in evaluating suspected neurogenic TOS. Imaging techniques like duplex ultrasound are also recommended for vascular TOS, especially when symptoms suggest venous or arterial compression.
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TOS is more prevalent in those with poor muscle development and poor posture
Thoracic outlet syndrome (TOS) is a group of disorders that cause pain and other symptoms in the upper body. It occurs when bones or muscles in the upper chest compress nerves or blood vessels in the lower neck and upper chest. This compression can be caused by anatomical variations, such as the presence of certain muscles or the overlapping insertion of others, which reduce the space in the thoracic outlet and lead to TOS.
The condition is considered controversial within the field of musculoskeletal medicine due to its complex presentation and challenges in diagnosis. Diagnosis of TOS involves a physical examination, including movement-based tests, and a review of the patient's medical history. Electrodiagnostic testing and imaging are also used to support diagnosis, particularly when clinical findings are inconclusive.
Poor posture is a risk factor for TOS, and the condition can be treated and symptoms improved through physical therapy, which helps to strengthen muscles and promote better posture. People with TOS may be advised to avoid carrying heavy bags on their shoulders or lifting objects above their heads, and to modify their daily activities to limit or avoid certain movements that trigger symptoms.
As such, it can be concluded that TOS is more prevalent in those with poor muscle development and poor posture. Poor muscle development can lead to reduced space in the thoracic outlet, increasing the likelihood of compression. Additionally, poor posture can contribute to the compression of nerves and blood vessels, further increasing the risk of developing TOS.
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Frequently asked questions
The network of nerves that passes through the thoracic outlet is called the brachial plexus. The thoracic outlet is bordered anteriorly by the anterior scalene muscle, posteriorly by the middle scalene, and inferiorly by the first rib. Therefore, the scalene muscles in the neck are affected by thoracic outlet syndrome.
Thoracic outlet syndrome (TOS) occurs when nerves or blood vessels are compressed in the lower neck and upper chest. Symptoms include pain, tingling, numbness, and weakness. TOS pain gets worse when the affected arm is raised.
TOS can be caused by a structural issue, such as an extra rib, the growth of a tumor, or an injury to the area. However, it is more often a functional issue caused by poor posture or chronic muscle tension in the neck, shoulders, and chest.
