Cluster of Neurogenic or vascular symptoms caused by the compression of the neurovascular bundle at the thoracic outlet (1)
Cervical rib syndrome, Scalene Anticus syndrome, Costoclavicular syndrome, Hyperabduction syndrome
Boundaries of Thoracic Outlet – Spinal Column, First Rib, Sternum
Neurovascular Compression in 3 possible spaces
Etiology and Pathogenesis:
Combination of genetic predisposition and trauma – acute or chronic/repetitive
Anatomic predisposition separated into Soft tissue (70%) and Osseous Abnormalities (30%) (2)
Soft Tissue Abnormalities
None available – likely secondary to differing definitions sited
Classic patient, young thin female, forward posture with neck flexion and anteriorly located glenohumeral joint (1)
90% Neurogenic, 3% Venous, <1% Arterial
Figure 2 – Allen test/Wright Test :Arm abducted and in posterior scaption, with head turned in contralateral direction to tested side. +ve test is loss of pulse.
Figure 3 – Roos Test: Patient is asked to hold flexed pose, inability to hold pose on affected side represents a positive test.
Figure 4 – Adson test: Patient’s arm is held in extension and 30 deg of abduction with head turned towards/ispilaterally to affected arm. Loss of pulse results in a positive test.
Management: (Evidence Based)
Dr. Daniel Abourbih (October 20, 2015 PR ND)
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