Thoracic outlet syndrome

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Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and various nerves and blood vessels between the base of the neck and axilla (armpit).

Causes

For the most part, these disorders are produced by positional compression of the subclavian artery and vein, the vertebral artery, and the nerve cords of the brachial plexus.

TOS may also result from a cervical band, abnormalities of the scalene muscles (including hypertrophy) and trauma.

Classification

The following taxonomy of TOS is used in ICD-9-CM and other sources:

Scalenus anticus syndrome (compression on brachial plexus and/or subclavian artery caused by muscle growth) - diagnosed by using Adson's sign with patient's head turned outward
Cervical rib syndrome (compression on brachial plexus and/or subclavian artery caused by bone growth) - diagnosed by using Adson's sign with patient's head turned inward
Costoclavicular syndrome (narrowing between the clavicle and the first rib) -- diagnosed with costoclavicular maneuver^[1]

Diagnosis

Adson's sign and the costoclavicular maneuver are notoriously inaccurate, and may be a small part of a comprehensive history and physical examination of a patient with TOS. There is currently no single clinical sign that makes the diagnosis of TOS with certainty. Arteriography, while only rarely used to evaluate thoracic outlet syndrome, may be used if a surgery is being planned to correct an arterial TOS.^[2]