Thoracic outlet syndrome

What is it?

  • Thoracic outlet syndrome is collective term for a group of conditions, which produce impingement/irritation of the neurovascular bundle (brachial plexus and subclavian/axillary artery and vein).
  • Thoracic outlet syndrome may mimic cervical nerve root symptoms with pain and pins and needles (paraesthesia) in a dermatomal distribution but it is not truly neck-based (cervicogenic).
  • There is a occupational predisposition with those that undertake more repetitive work using the hands more likely to have symptoms eg. Hairdressers/production line workers

What are the symptoms?

  • Pain and paraesthesia in arm and hand (most commonly ulnar nerve distribution)
  • Often described as hand “goes to sleep”
  • Decreased sensation and weakness neurologically
  • May have Oedema (swelling) and pallor (white) in hand
  • Pain described as deep, dull and vague

What are the causes?

The three suspected mechanisms are: -
  • Anterior scalene syndrome
  • Costoclavicular syndrome
  • Pectorals minor syndrome

Thoracic outlet syndrome