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Thoracic Outlet Syndrome

Damage to eighth cervical and first thoracic nerve roots (part of brachial plexus) and/or subclavian vessels either by compression over a cervical or abnormal thoracic rib or an aberrant fibrous band¹.

Epidemiology
Risk factors Most commonly seen in middle-aged women ²

Presentation
Symptoms Muscles weakness and atrophy of the hand and wrist. Pain, loss of sensation and tingling in the medial forearm and little and first fingers. Pain often follows carrying heavy items. Occasionally, cyanosis and swelling of arm. Less commonly, Raynaud's phenomenon.

Signs Occasionally Horner's syndrome, bruits at clavicle or in axilla. Damage to the lower part of the brachial plexus may lead to weakness and wasting of the small hand muscles, and of the medial forearm wrist and finger flexors¹.

Investigations X-ray for cervical rib, nerve conduction studies.

Management
Non-drug Physiotherapy.

Surgical First (59.6%) and cervical costae (21.3%) resections³ may lead to improvement in pain and paraesthesiae, but there is frequently residual muscle weakness and results deteriorate with time¹

References Used

1. Thomas PK in Oxford Textbook of Medicine, 4th Edition. Eds; Warrell DA et al. OUP 2003.
2. The Merck Manual - Thoracic Outlet Compression Syndromes
3. Balci AE, Balci TA, Cakir O, et al; Surgical treatment of thoracic outlet syndrome: effect and results of surgery.;Ann Thorac Surg 2003 Apr;75(4):1091-6; discussion 1096.[abstract]

Acknowledgements EMIS is grateful to doctoronline.nhs.uk for facilitating draft authoring of this article and to Dr Laurence Knott for his additions. The final copy has passed peer review of the independent Mentor GP authoring team. ©EMIS 2004.

Last issued 07 Sep 2004