Thoracic Outlet Syndrome (TOS) is a pathological condition that is caused by the compression of nerves and blood vessels in the area between the clavicle and first rib, also known as the thoracic "inlet". This narrow gap is the home to nerves, blood vessels and muscles. TOS encompasses a variety of clinical problems that involve upper extremity pain, neurological, and vascular symptoms due to compression or traction of brachial plexus, subclavian artery, or subclavian veins. The anatomy of the thoracic outlet predisposes the body to this syndrome given the numerous essential structures that pass through a relatively small space.1
There are three types of TOS: neurogenic, vascular and disputed. Neurogenic TOS is caused by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand. In the majority of thoracic outlet syndrome cases, the symptoms are neurogenic. Vascular TOS is described as compression of the artery or vein in the thoracic outlet. The final type, disputed TOS, contains no neurological deficits, however, the patients have TOS symptoms and pain. All health care professionals should be familiar with the presenting signs and symptoms of TOS, and include the syndrome in their differential diagnosis. TOS typically presents with aching-type pain radiating from the scapula down the upper extremity, with associated numbness or tingling. It is common in women between 20 and 50 years of age. However, TOS can cause Paget–Schroetter syndrome in young male laborers. This branch of the pathology is primarily an axillo-subclavian deep vein thrombosis (DVT) and is most often the consequence of a chronic compression of the subclavian vein at the level of the thoracic outlet.
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