Thoracic Outlet Syndrome: Types, Diagnostic tests and more

What is Thoracic Outlet Syndrome?

The condition known as thoracic outlet syndrome (TOS) is brought on by the compression or constriction of the nerves or blood vessels in the thoracic outlet. 

Important nerves and blood vessels that supply the arm and hand are located in the thoracic outlet, which is the small space between the collarbone (clavicle) and the first rib. Pain, numbness, tingling, and weakness in the arm, shoulder, and hand are just a few of the symptoms that can result from TOS.

Three main categories of TOS exist:

Neurogenic TOS: 

The most prevalent form of TOS, known as neurogenic TOS, is brought on by compression of the brachial plexus, a web of nerves that starts in the neck and supplies the arm and hand. Trauma, repetitive overhead activities, bad posture, and anatomical abnormalities are just a few of the causes of neurogenic TOS.

Vascular TOS: 

The subclavian artery or vein, which supplies blood to the arm and hand, is compressed, resulting in vascular TOS. Less frequent than neurogenic TOS, vascular TOS can result from trauma or anatomical abnormalities.

Nonspecific TOS: 

This kind of TOS is characterized by symptoms that cannot be linked to a particular nerve or blood vessel being compressed. Muscle tension, bad posture, and stress are just a few of the causes of nonspecific TOS.

Symptoms of TOS:

Depending on the kind and degree of the condition, there can be a wide range of TOS symptoms. Typical signs include:

Neurogenic TOS:

• Occipital headache, shoulder and neck pain
• Burning pain, numbness and tingling in upper extremity
• Muscle spasm in upper back region
• Muscle wasting ( Gilliant-Summer hand)
• Muscle weakness

Venous TOS:

• Cyanotic discoloration and heaviness of arm
• Abrupt swelling and pain in arm

Arterial TOS:

• Arm or hand numbness or tingling
• A weakened hand or arm
• Cramping or Claudication in the hand or forearm with activity
• Hand coldness or discoloration
• Absence of neck and shoulder pain
• Non-healing wound in fingers

Diagnostics ways:

Because the symptoms of TOS can resemble those of other conditions, including cervical radiculopathy and carpal tunnel syndrome, diagnosing TOS can be difficult. Confirmation of the diagnosis can be aided by a thorough physical examination, a detailed medical history, and imaging tests like X-rays, MRIs, or CT scans.

The diagnosis of thoracic outlet syndrome can be made with the aid of a number of specialized tests (TOS). These examinations are intended to determine whether and how much the thoracic outlet's blood vessels or nerves are being compressed.

Adson's Test: The subclavian artery is checked for compression using the Adson's test. The patient is seated with an elbow bent at a right angle and an arm at the side. The patient tilts their head to the affected side and extends their neck as the therapist feels the radial pulse. A test result is positive when the pulse weakens or stops altogether.

Roos Test: The Roos test is used to evaluate neurogenic TOS. The patient is seated with their elbows bent and their arms abducted to 90 degrees. In order to check for signs of exhaustion, weakness, or numbness, the patient moves their hands open and shut for three minutes.

Wright's test: This test determines whether a patient has vascular TOS. The patient is lying on his or her side with the elbow bent 90 degrees. While the patient's arm is externally rotated and abducted, the therapist feels the radial pulse. A test result is positive when the pulse weakens or stops altogether.

The costoclavicular manoeuvre: It is a test used to determine whether the subclavian vein is being compressed. The patient is positioned in a seated position with the shoulders lowered and the head turned to the injured side. While the patient inhales deeply and holds it, the therapist feels the radial pulse. A weakening or loss of the pulse signals a successful test.

The Roos stress test: It is used to determine whether someone has neurogenic TOS. The patient is seated with the elbows bent and the arms 90 degrees abducted. The patient rotates their head from side to side while opening and closing their hands for three minutes. The therapist keeps an eye out for symptoms of weakness, fatigue, or numbness.

Treatment:

The underlying cause and severity of TOS will determine how it is treated. Conservative medical options could be:

Physical Therapy: Exercises for stretching and strengthening, postural training, and manual therapy methods like joint mobilisation or soft tissue massage can all be included in physical therapy.

Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, and muscle relaxants can all be used to help manage pain and inflammation.

Ergonomic changes: These might involve modifying workstations or avoiding activities that make symptoms worse.

Surgery: In some circumstances, surgery may be required to release pressure on the nerves or blood vessels.