(Golden oldie) Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis

Review written by Sam Spinelli info

Key Points

  1. The thoracic outlet is a highly dense anatomical region which has structures passing through it related to the vascular and nervous systems.
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BACKGROUND & OBJECTIVE

Thoracic outlet syndrome (TOS) is a diagnosis that is often either missed, labelled as a more commonly seen condition like a rotator cuff tear, or inappropriately used and given to someone who doesn’t fit the appropriate criteria (1). TOS can be very limiting, potentially affecting the thoracic spine, shoulder, neck, and arm. Many clinicians are not well educated on TOS and don’t fully understand the anatomy or various contributing factors to appropriately diagnose or treat this condition (1). In last month’s issue (July 2020) I reviewed a paper on the treatment/management of TOS. This paper by the same authors instead looked at the patho-anatomy and diagnosis of TOS.

TOS can be very limiting, potentially affecting the thoracic spine, shoulder, neck, and arm.
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When working with individuals with neck, shoulder, or arm pain, as well as signs or symptoms related to vascular or nerve function, thoracic outlet syndrome should be a consideration in your differential diagnosis.

ANATOMY

The thoracic outlet can be thought of as approximately the area between the first rib and collarbone, extending from the interscalene triangle to the axilla. There are three main locations within the thoracic outlet that are relevant for confinement: the

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