Thoracic outlet syndrome: Difference between revisions
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==Background== | ==Background== | ||
[[File:Thoracic Outlet Syndrome.png|thumb|Drawing of thoracic outlet syndrome.]] | |||
[[File:Gray808.png|thumb|The right brachial plexus with its short branches, viewed from in front. The Sternomastoid and Trapezius muscles have been completely removed, the Omohyoid and Subclavius have been partially removed; a piece has been sawed out of the clavicle; the Pectoralis muscles have been incised and reflected.]] | |||
[[File:Anatomy of the thoracic inlet.png|thumb|Anatomy of the thoracic outlet.]] | |||
*Symptoms from compression of neurovascular bundle at thoracic outlet | *Symptoms from compression of neurovascular bundle at thoracic outlet | ||
*Neuro complications most common (95%), then venous compression (3%), and then arterial (1%) | *Neuro complications most common (95%), then venous compression (3%), and then arterial (1%) | ||
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==Clinical Features== | ==Clinical Features== | ||
*Pain, numbness or weakness in upper extremity aggravated by elevating hands | *Pain, [[numbness]] or [[weakness]] in upper extremity aggravated by elevating hands | ||
**Neck rotation, arm abduction or UE external rotation may elicit symptoms | **Neck rotation, arm abduction or UE external rotation may elicit symptoms | ||
*Sensory deficits common along T1 distribution | *Sensory deficits common along [[focal neuro|T1 distribution]] | ||
*Swelling, claudication pain & cyanosis with activity if venous compression | *Swelling, claudication pain & cyanosis with activity if venous compression | ||
*Hand ischemia (pain, pallor, paresthesia, cold) if arterial compression | *Hand ischemia (pain, pallor, paresthesia, cold) if arterial compression | ||
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{{Shoulder DDX}} | {{Shoulder DDX}} | ||
== | ==Evaluation== | ||
*CXR | *[[CXR]] | ||
*Consider duplex | *Consider duplex [[ultrasound]] if venous/arterial compression suspected | ||
==Management== | ==Management== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[ | [[Category:Neurology]] | ||
Latest revision as of 22:11, 13 November 2024
Background
- Symptoms from compression of neurovascular bundle at thoracic outlet
- Neuro complications most common (95%), then venous compression (3%), and then arterial (1%)
- Scalene triangle most often involved area: borders are anterior scalene, middle scalene and first rib
Clinical Features
- Pain, numbness or weakness in upper extremity aggravated by elevating hands
- Neck rotation, arm abduction or UE external rotation may elicit symptoms
- Sensory deficits common along T1 distribution
- Swelling, claudication pain & cyanosis with activity if venous compression
- Hand ischemia (pain, pallor, paresthesia, cold) if arterial compression
- Almost always has cervical/anomalous rib
- May have tender scalene muscles
- Thrombus may develop from vascular compression
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
- CXR
- Consider duplex ultrasound if venous/arterial compression suspected
Management
- Physical therapy as outpatient
- Treat embolus if present
- Consider interscalene injection
Disposition
- Home