Compression of the brachial plexus can cause paraesthesia and/or motor weakness, which is often in the ulnar distribution there may be muscle wasting, and pain can radiate to the neck and upper part of the back.Symptoms may also worsen with certain movements, e.g. The specific clinical features present will be dependent on neurological, arterial, or venous involvement. *It is more common in athletes that use repetitive arm motions, such as swimming and racquet sports, and in bodybuilders Clinical Features Recent trauma, repetitive motion occupations, athletes*, or anatomical variations are potential risk factors for TOS Any restrictive bands can be released too (or even the anterior scalene muscle), if also impinging on surrounding structures.Ĭomplications of TOS surgery include the neurological or vascular damage, or haemothorax, pneumothorax, or chylothorax (particular on the left, the thoracic duct is within the thoracic outlet can is at risk of damage). Elective surgery in aTOS or vTOS typically corrects symptoms in 90-95% of cases, but only in 50-70% in nTOS.įor decompression procedures, this can either be via a supraclavicular or transaxillary approach, allowing access to excise the first or cervical rib. Surgical procedures should be considered if conservative measures do not work or anatomical variations require correction (required in around 10% of cases). However, most cases are causes by anatomical abnormalities that can be managed in the elective surgical setting. Patients with vTOS may need thrombolysis and anti-coagulation, under guidance form the haematology teams, however most cases will need surgical management to decompress the thoracic outlet, as well as venoplasty or venous reconstruction or the placement of a venous stent.įor aTOS with acute limb ischaemia, urgent vascular input is required, as the patient may warrant an embolectomy. Botulinum toxin injections can also be effective to help relax the scalene muscles, often done concurrently to aid physiotherapy. The treatment approach depends upon the type of TOSįor nTOS, the first line management is physiotherapy, over the course of around 6 months, aiming to improve mobility in the neck and shoulder, strengthen the surrounding muscles, and relax the scalene muscles.
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