Neurogenic Thoracic Outlet Syndrome
- Description / Cause
- Impingement of the brachial plexus passing through the scalene triangle
- Above first rib and behind the clavicle
- Sites of compromise: Interscalene triangle (most common), costoclavicular triangle, subcoracoid space deep to pectorals minor tendon, and cervical or upper ribs
- Chronic cervical muscle spasm
- Whiplash injury
- Trauma from external source
- Compression of brachial plexus is HALLMARK: C8-T1
- Prevalence / Risk factors
- Neurogenic is most common type (95% of TOS cases)
- 3rd-5th decade in life
- Females
- 3.5-4.1:1
- 3-80cases/1,000 individuals
- Upper extremity, repetitive motions
- Congenital first rib predisposition
- Repetitive stress on scalenes
- Signs / Symptoms
- Pain
- Overhead activities
- Carrying heavy load
- Posture and head position
- Weakness
- Arm and hand heaviness
- Numbness
- Tingling of upper extremity
- Sensory loss
- Most common in ulnar distribution followed by median nerve
- Shoulder and neck discomfort
- Headache
- Sympathetic nervous system impairment
- Nocturnal symptoms
- Arterial and venous compression; "white" hand, swelling, fatigue
|
Roo's Test |
- Treatment / Interventions
- Conservative
- Physical Therapy
- Stretching
- Strengthening
- Postural adjustment
- Neuromuscular scalene block
- Lifestyle modifications
- Surgery
- First rib resections
- Medication
- Tricyclic antidepressants
- SNRIs
- Gabapentin
- NSAIDs
- Muscle relaxants
- Differentially diagnose
- Pancoast tumor
- Distal peripheral neuropathies
- Cervical radiculopathy
References
- Orlando M, Likes K, Freischlag J, et al. A Decade of Excellent Outcomes after Surgical Intervention in 538 Patients with Thoracic Outlet Syndrome. Journal Of The American College Of Surgeons [serial online]. May 2015;220(5):934-939. Available from: Academic Search Complete, Ipswich, MA. Accessed June 18, 2015.
- Pritzlaff S, Carinci A, Christo P. Neurogenic thoracic outlet syndrome: An often overlooked but treatable condition. Journal Of Family Practice [serial online]. September 3, 2013;:S16-S21. Available from: Academic Search Complete, Ipswich, MA. Accessed June 18, 2015.
- Robertson E, Reimche, D. Differential Diagnosis for Various Neuropathies at the Elbow. Accessed June 30, 2015.
Acknowledgements:
David Funk, Student Physical Therapist at A.T. Still University
Ethan Hunke, Student Physical Therapist at A.T. Still University
Morgan Johnson, Student Physical Therapist at A.T. Still University
Ed Nheiu, Student Physical Therapist at A.T. Still University
Lindsay Walczak, Student Physical Therapist at A.T. Still University
Last edited: July 13, 2015
David Funk, Student Physical Therapist at A.T. Still University
Ethan Hunke, Student Physical Therapist at A.T. Still University
Morgan Johnson, Student Physical Therapist at A.T. Still University
Ed Nheiu, Student Physical Therapist at A.T. Still University
Lindsay Walczak, Student Physical Therapist at A.T. Still University
Last edited: July 13, 2015