TOS

Question 1

What structures cause Thoracic outlet syndrome if they are compressed or have tension on them? Which one is more common?

Answer 1

1. brachial plexus*** (90% of cases)
2. subclavian vein
3. subclavian artery

Question 2

(true/false) TOS is a common pathology

Answer 2

FALSE

Question 3

What are the 3 common entrapment sites?

Answer 3

1. interscalene triangle
2. costoclavicular space
3. sub-pectoralis minor space

Question 4

What are the borders of the interscalene triangle?

Answer 4

• anterior scalene (anterior border)
• middle scalene (posterior border)
• 1st rib (inferior border

Question 5

What passes through the interscalene triangle?

Answer 5

subclavian artery and brachial plexus

Question 6

What are the borders of the costoclavicular space?

Answer 6

• clavicle ( anterior border)
• 1st rib (posteromedial border)
• superior border of the scapula (posterolateral border)

Question 7

What structures pass through the costoclavicular space?

Answer 7

• brachial plexus
• subclavian artery
• subclavian vein

Question 8

Where is the sub-pectoralis minor space located?

Answer 8

• below the coracoid process/under pec minor’s insertion

Question 9

What structures pass through the sub-pectoralis minor space?

Answer 9

• brachial plexus
• subclavian artery
• subclavian vein

Question 10

Who is at a higher risk of getting TOS?

Answer 10

Females
20-50 y/o
pts with elevated 1st ribs
pts with a FWD head and rounded shoulder posture

Question 11

What is the common symptom presentation of TOS brachial plexus compression?

Answer 11

• numbness/tingling into 4th/5th digit of the hand
• numbness/tingling at night and during activity
• hand/arm weakness with overload reaching
• vague pain in hand, elbow, shoulder, or cervical spine
• complaints of swelling sensation in the arm when there is no swelling present

Question 12

What type of TOS compression is most common?

Answer 12

brachial plexus compression (90% of cases)

Question 13

What is the common symptom presentation of TOS arterial compression (3/4 of cases)?

Answer 13

• loss of radial pulse at rest
• coldness/pallor of arm and hand
• fatigue of UE
• tender lump or pulsating subclavian artery in the costoclavicular space

Question 14

What is the common symptom presentation of TOS venous compression (6-7% of cases)?

Answer 14

• swelling of UE
• cyanosis of UE
• arm discomfort
• symptoms increasing with repetitive use of UE
• distended superficial veins in the arm or chest

Question 15

What is the precipitating factor of venous compression with TOS?

Answer 15

excessive use of the UE ( mostly with working overhead)