Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a condition caused by the compression of nerves or blood vessels in the thoracic outlet. The thoracic outlet is a region near the neck and upper chest made up of the interscalene triangle, costoclavicular space, and retropectoralis minor space. TOS is classified into three types: neurogenic, venous, and arterial. Each of these three presents distinct symptoms. Neurogenic TOS targets the brachial plexus nerves, causing arm pain, numbness, and weakness. Venous and arterial TOS impact blood flow, which then causes
swelling, discoloration, or coldness in the affected limb.

Diagnosing TOS can be challenging because its symptoms often overlap with other conditions such as carpal tunnel syndrome or cervical disc disease. To best diagnose TOS, a combination of physical exams, imaging, and nerve tests are typically necessary to properly pinpoint the type and cause. Most cases of TOS improve with conservative treatments such as physical therapy, posture correction, and lifestyle adjustments. These treatments tend to work as they reduce compression on neurovascular structures. Although, in some cases, it may be necessary to discuss surgical intervention to relieve compression. In such cases, surgery may look like removing a cervical rib or another obstructive tissue, depending on the type of TOS. There is a promising future for the treatment of TOS. New therapies like botulinum toxin and anesthetic injections may help offer symptom relief and insights for potential surgical outcomes. With a multidisciplinary approach, TOS management continues to evolve, offering
hope for improved outcomes and quality of life for affected individuals.

Source:
Capodosal, Gerardo MD1; Holden, Diane MD1; Maloy, Wyatt MD, MS1; Schroeder, Jeremy D. DO, ATC2. Thoracic Outlet Syndrome. Current Sports Medicine Reports 23(9):p 303-309, September 2024. | DOI: 10.1249/JSR.0000000000001192

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