Thoracic Outlet Syndrome

What are the anatomical borders for the thoracic outlet

First thoracic rib
Clavicle
Superior border of the scapula

What passes through the thoracic outlet

Great vessels and nerve of the upper extremity

What are the three primary site for compression or entrapment of the neurovascular structures associated with TOS

Interscalene triangle
Costoclavicular junction
Interpectoral space

Interscalene triangle border

Scalenus anterior and medius muscles and the first rib

What reproduces symptoms associated with interscalene triangle compression

Adson’s maneuver

With interscalene triangle compression what happens if the artery is compressed

The pulse decreases

How do you decrease symptoms associated with interscalene triangle compression

Stretch the scalene muscles

Costoclavicular space border

Clavicle superiorly and the first rib inferiorly

Where does compression occur with costoclavicular space compression

Between the clavicle and the first rib

What are some things that can lead to costoclavicular space compression

Depressed clavicle while carrying heavy object in the hand or on the shoulders
Slouched posture
Fractured clavicle
Anomalies in the region
Elevated first rib → due to rib subluxation or upper thoracic breathing

What test can reproduce symptoms caused by a depressed clavicle

Military Brace Test (where the shoulders are retracted and depressed)

How would you decrease symptoms associated with costoclavicular space compression

Mobilization of the first rib

Axillary interval border

Anterior deltopectoral fascia
Pectoralis minor
Coracoid process

Compression in the axillary interval occurs in this region due to what

Pectoralis minor is tight owing to faulty posture with the scapula tipped forward
Repetitive overuse

What tests are indicated for axillary interval compression

Wright test
Roos test

How would you decrease symptoms associated with axillary interval compression

Stretch the pectoralis minor

What are the typical signs and symptoms associated with neurological TOS

Numbness
Tingling
Weak grip
Loss of manual dexterity (intrinsics)

What are the typical signs and symptoms associated with arterial TOS

Cool
Pale extremity

What are the signs and symptoms associated with venous TOS

Swelling
Mottled discoloration