![]() ![]() The axillary-subclavian vein traverses the tunnel formed by the clavicle and subclavius muscle anteriorly, the scalenus anticus muscle laterally, the first rib posterior-inferiorly, and the costoclavicular ligament medially. The brachial plexus follows the route of the subclavian artery, but it lies a little more posteriorly and laterally. The subclavian vein has an identical course, except that it passes anteriorly rather than posteriorly to the scalenus anticus muscle. It then passes under the clavicle and finally enters the axilla beneath the pectoralis minor muscle. The subclavian artery leaves the thorax by arching over the first rib behind the scalenus anticus muscle (anterior scalene) and in front of the scalenus medius muscle (middle scalene). Finally, a nerve conduction study may be recommended if there is the possibility of any nerve damage.Knowledge of the thoracic outlet anatomy is fundamental to the diagnosis of any type of TOS. To check the blood vessels, either an angiography, arteriography or venography may be recommended. In order to confirm a diagnosis your doctor may recommend imaging tests such as x-rays, ultrasound or CT or MRI scans. You may be asked to move your arms, shoulders or neck into different positions to determine if any pain or other symptoms occur (this is called 'provocation testing'). Arterial pulse either absent or decreased on the affected side.Ī doctor will first review medical history and current symptoms and then conduct a physical examination to check for any of the symptoms listed above.One hand noticeably cooler than the other.Skin discolouration on the arm – either a bluish colour or paleness of the skin.Symptoms of vascular thoracic outlet syndrome may also include… Weakness, or a tingling or numbing of the arm or hand.Pain that worsens as the arm is lifted or during repetitive arm movements or when turning the head or neck.Pain in the arm – this can be in the form of an ache or a stabbing or burning pain.Symptoms can be divided into those that occur in both type of the condition, and those that only occur with vascular thoracic outlet syndrome. Most symptoms of the condition affect the neck, the arms and hands and the shoulders and sometimes the chest and upper back. Pregnancy – joints and ligaments naturally loosen during pregnancy. ![]() Injury to the neck (especially whiplash in car accidents, but also consistently carrying around heavy bags or backpacks).stocking shelves, typing on a computer) or in certain sports, for example swimming, volleyball, golf and weightlifting. Overuse of the arms and/or shoulders - this is relatively common where heavy loads are frequently carried on the shoulders, or in jobs which require very repetitive movements of the arms (e.g.Congenital anatomical differences – a small number of people have an extra rib or particularly tight fibrous connective tissue in the area of the thoracic outlet which can place pressure on the nerves or blood vessels.The primary cause of the condition is injury or compression of the blood vessels and/or nerves in the thoracic outlet. It is unusual for the condition to develop under the age of 20 or over the age of 50. The condition (sometimes simply referred to as 'TOS') affects around 1% of the population, with women over twice as likely to develop it than men. Thoracic outlet syndrome describes where either the blood vessels (vascular thoracic outlet syndrome) or the nerves (neurological thoracic outlet syndrome) become injured, entrapped or compressed in the thoracic outlet.īy far the most common of these is neurological thoracic outlet syndrome. Nerves, arteries and veins pass through the thoracic outlet – specifically the nerves in the brachial plexus, the subclavian artery and the subclavian vein. The thoracic outlet is a narrow passage located inside the body between the neck and the shoulder. ![]()
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