Both nonsurgical and surgical treatment methods are options for patients in managing this condition. Electrodiagnostic studies can also be useful if the condition is neurologic in origin. Imaging of the musculature and vasculature can help identify this condition. Patients present with a wide range of symptoms, from minor complaints to debilitating manifestations. The first rib, scalene muscles, and the clavicle comprise the thoracic outlet. Wilbourne suggests five different types of TOS a venous variant, arterial, a traumatic, a true neurogenic, and a disputed neurogenic. TOS was first reported by Rogers in 1949 and more precisely characterized by Rob and Standeven in 1958. TOS specialists with the Thoracic Outlet Syndrome Center at Washington University and Barnes-Jewish Hospital are working to gain a better understanding of these issues as well as to provide expert care to patients affected by all forms of TOS.Thoracic outlet syndrome (TOS) is a nonspecific diagnosis representing many conditions that involve the compression of the neurovascular structures that pass through the thoracic outlet. Best methods to reduce symptomatic recurrence.Expected outcomes following different types of surgical and nonsurgical treatments.Criteria to help select patients for different forms of treatment.Diagnostic criteria to differentiate neurogenic TOS from other cervical-brachial syndromes.The precise changes to the body caused by the syndrome.There are still many unresolved issues related to neurogenic TOS including: surgical decompression based on scalenectomy and brachial plexus neurolysis, with or without first rib resectionįor patients with symptoms referable to the subpectoralis space (sometimes termed the “hyperabduction syndrome”), surgical decompression may include a tenotomy, or surgical division of the pectoralis minor tendon.botulinum toxin chemodenervation of the scalene/pectoralis muscles to eliminate muscle spasm.Properly identified and selected patients can nonetheless respond quite well to treatment, consisting of one or more of the following treatment options: Neurogenic TOS can be especially debilitating as it can result in chronic pain syndromes that are challenging to treat with conservative care modalities. TOS specialists therefore rely largely on clinical findings and a limited number of additional tests to identify patients with neurogenic TOS. The results of conventional electrophysiological testing and imaging in patients with neurogenic TOS are often within normal ranges or are nonspecific. Known to include pain and muscle spasm frequently extending to the upper arm, neck, and back.Typically dynamic, with marked positional exacerbation during arm abduction, elevation, and other maneuvers.Differing day-to-day, depending on levels of activity.Symptoms of brachial plexus nerve root compression consist of the following, located in the shoulder, arm, or hand: history of neck or upper extremity injury resulting in scalene muscle spasm, fibrosis, and other pathological changesĪn additional site of nerve compression may occur just beyond the first rib, within the space underlying the pectoralis minor muscle tendon.congenital variations in anatomy – such as anomalous scalene musculature, aberrant fibrofascial bands, or cervical ribs.Neurogenic TOS is most frequently characterized by compression of the brachial plexus nerve roots (C5 to T1) within the scalene triangle.Ĭompression may be due to one or more of the following factors: Notice of Privacy Practice for Patients (HIPAA)įrom 85-95% of all patients with TOS are affected by neurogenic TOS.What Your Can Expect from Your Visit – Staying in St.What You Can Expect From Your Visit – Overview.Neurogenic Thoracic Outlet Syndrome (TOS).Arterial Thoracic Outlet Syndrome (TOS).Types of Thoracic Outlet Syndrome (TOS) Types of Thoracic Outlet Syndrome (TOS).Anatomy of the Thoracic Outlet Anatomy of the Thoracic Outlet.General Features of Thoracic Outlet Syndrome (TOS).
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