yogabook / pathologie / thoracic-outlet-syndrome

Thoracic outlet syndrome (TOS, narrowing syndrome of the upper thoracic aperture, shoulder girdle compression syndrome)

Definition of

Neurovascular compression syndrome of the upper thoracic aperture: nerves, arteries or large veins in the neck and chest area are compressed. Accordingly, a distinction is also made between neurogenic and vascular TOS. For the vascular nerve bundle consisting of brachial plexus nerves(from C5-Th1), subclavian artery and subclavian vein, there are three physiological constriction sites:

1. Anterior and posterior scalene gap („scalene syndrome“)
2. the costoclavicular space („costoclavicular syndrome“),
3. Coracopectoral space („hyperabduction syndrome“, „pectoralis minor syndrome“, mainly due to hypertrophy of the pectoralis minor, is mainly triggered by elevation and retroversion of the arm, also at night with the arm laid overhead).

Pressure on a nerve(brachial plexus or nerves extending from it) mainly causes paraesthesia; pressure on an artery (subclavian artery, posterior scalene gap) impairs the supply and leads to pallor, weakness, pain; pressure on a vein (subclavian vein, anterior scalene gap, „thoracic inlet syndrome“, risk of thrombosis!) leads to congestion. Peak: Women between 35 and 55 years of age. Incidence in Germany in 2019: 2082

ICD G54.0

Cause

1. Scalenus syndrome: cervical rib (cervical rib syndrome), exostoses, scalenus(anterior) hypertrophy(scalenusanteriorsyndrome), steep position of the 1st rib

Predisposing

1. Cervical rib (additional „zeroth“ rib)
2. thoracic anomalies of the ribs
3. Poorly healed clavicle fracture or rib fracture with callus formation
4. Anomalies of the Scaleni
5. narrow chest, long neck

Diagnosis

1. The clinical picture and the tests point the way. Even imaging cannot confirm or rule out TOS with certainty.
2. Nerve conduction velocity
3. EMG
4. MRI to clarify anatomical abnormalities
5. Angiography if necessary
6. Tests and signs: Roos test („elevated arm stress test“, „EAST“), Adson test, Wright test, Eden testTestsand signs for brachial plexus: Elvey test, brachial plexus stress test, birekle_sign, Bakody shoulder abduction test

Symptoms

A distinction must be made according to the anatomical structure affected. Particularly in the early stages, the symptom occurs depending on position/movement, especially when working overhead. If a nerve is affected:

1. Pain and tingling, initially in the shoulder/neck area, later radiating to the inner upper arm, possibly as far as the hand, usually in the innervation area of the roots C8-T1
2. possibly vegetative vascular changes
3. rare: paretic hand

a vein:

1. Congestion, possibly with cyanotic discoloration

an artery:

1. Pallor, coolness, possibly pulselessness of the arm
2. In extreme cases, Raynaud’s syndrome: usually white, painful, numb fingers

Complications

1. Thoracic inlet syndrome: thrombosis („Paget-von-Schroetter syndrome“)

Therapy

1. PT, massage
2. Exercise therapy: strengthening the shoulder girdle muscles
3. If necessary: surgery. This does not require physiotherapeutic follow-up care
4. Heat to relax the muscles
5. An effective drug therapy does not exist

DD

1. cervical discopathy
2. Tumors