Thoracic outlet syndrome : A Narrative Review
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Abstract
Thoracic outlet syndrome (TOS) refers to a group of disorders that occur when the blood vessels or nerves in the space between the collarbone and first rib (thoracic outlet) become compressed. This can cause pain in the shoulders and neck as well as numbness in the fingers. The most common causes of TOS are physical trauma from a car accident, repetitive injuries from sports or work, poor posture, and anatomical defects or conditions present from birth.
There are three main types of TOS: neurogenic (compression of the brachial plexus nerves), venous (compression of the subclavian vein), and arterial (compression of the subclavian artery). Typical symptoms include pain, weakness, numbness, swelling, discoloration, and coldness in the arm and hand. Diagnosis often involves physical examination maneuver that look for neurological symptoms or vascular compression as well as imaging tests like x-rays, CT scans, or MRI.
First line treatment for TOS is conservative measures such as physical therapy, posture correction, pain medications, and avoiding activities that trigger symptoms. Surgery may be an option for those who do not improve with conservative treatment. Surgery aims to increase the space in the thoracic outlet area and can be done with either an open or arthroscopic approach. With appropriate management, most patients with TOS can experience decreased symptoms.
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