ADD-ONS / OTHER VASCULAR DISORDERS
Thoracic Outlet Syndrome (TOS)
Created 15/02/2022, last revision 10/01/2023
The anatomical condition of the upper thoracic aperture, with or without additional external factors, predisposes to chronic pressure damage of the brachial plexus and to vessels compression. This is particularly true for the caudal portion. Since exact pathogenetic mechanisms cannot always be proven, the general term thoracic outlet syndrome (TOS) is used.
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Classification of Thoracic Outlet Syndrome
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Etiology
- anatomical defects
- cervical rib, ligamentous band between the spine and rib
- faulty posture
- drooping shoulders with anteflexion of the head
- trauma
- difficulties may occur with a delay
- repetitive, monotonous work
- working at the computer, working on a production line, working with prolonged hand-holding
- sports (e.g., swimmers)
- repetitive carrying of loads over the shoulder
- pregnancy
- due to the loosening of the joints, TOS may appear during pregnancy
Clinical presentation
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Diagnostic evaluation
Personal history, clinical examination, provoking tests
Other examination methods
- X-ray of the upper thoracic outlet
- look for cervical rib
- exclude other structural pathologies
- dynamic DSA/CTA or the Doppler ultrasound (during provocation tests)
- direct demonstration of artery compression and determination of its severity
- detection of post stenotic dilatation, detection of intraluminal thrombi within the dilated segment
- flow pattern changing during the provoking maneuver (ultrasound)
- dampened flow in distal segments + high-resistence flow in the proximal subclavian artery
- MRI
- can help to localize the site of plexus or subclavian artery compression
- it can detect a fibrous band between the spine and the 1st rib or cervical rib
- EMG
- detects neuropathic changes
Management
Conservative treatment
- physiotherapy with the strengthening of corset and shoulder muscles, posture improvement → see here
- relaxation techniques
- medication (non-steroidal anti-inflammatory drugs – NSAID)
Surgical treatment
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