Thoracic Outlet Syndrome
Description
Thoracic outlet syndrome (TOS) is a nonspecific diagnosis that refers to an array of conditions caused by compression of the neurovascular structures that pass through the thoracic outlet of the neck, shoulder, and scapula regions. The most prevalent TOS categories are neurogenic TOS (NTOS) with more than 95% of all TOS cases, venous TOS (VTOS) with 2-3% of all cases, and arterial TOS (ATOS) with less than 1% of all cases.
Signs & Symptoms
NTOS
- Common onset after trauma (i.e. motor vehicle accidents)
- Involves scalene and cervical musculature
- Neck pain
- Parethesias radiating into the medial or lateral arm
- Occurs commonly after repetitive overhead activity
- Acute swelling of involved upper extremity with heaviness, effort-dependent pain, and parathesias
- Pleuritic chest pain and dyspnea from pulmonary embolization
- Neck pain and headache are UNCOMMON
- Usually asymptomatic until embolization occurs
- Hand and finger pain, parathesias, coldness, and color changes due to ischemia caused by embolism
- Shoulder and neck pain symptoms are UNCOMMON
Diagnostic Tests
Diagnostic tests, at best, have an average of 72% sensitivity and an average of 53% specificity, but during some of the maneuvers (Adson, Roos, etc.) the patient’s symptoms may be elicited supporting a diagnosis of TOS. The clinician should rule OUT:
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PT Implications
Fortunately, the most common form, NTOS, has good results with conservative, non-surgical treatment with an indication for physical therapy. The patient should be educated/treated by the therapist with:
- Behavior modification
- Ergonomic correction
- Relaxation exercises
- Manual therapy
- Stretching of neck and shoulder muscles
- Modalities
- Biofeedback