Thoracic outlet syndrome

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

Workup

• CXR
• Consider duplex u/s if venous/arterial compression suspected

Management

• Physical therapy as outpatient
• Treat embolus if present
• Consider interscalene injection

Disposition

• Home

References

UpToDate