Question

Thoracic outlet syndrome is constellation of signs and symptoms due to compression of the neurovascular bundle in the upper thorax.

1. What are the three main classifications?
2. What structures can compression the bundle?
3. What are the three physical examination maneuvers you can do at the bedside to help diagnoses?

Answer

• The main classifications of thoracic outlet syndrome are:
  • Neurogenic
    1. Most common
    2. Signs and symptoms include pain, paresthesias, numbness, and weakness
  • Venous
    1. 2nd most common
    2. Signs and symptoms include hand swelling, pain, cyanosis with repetitive activity
  • Arterial
    1. Least common
    2. Signs and symptoms include pain, pallor, paresthesias, and poikilothermia not related to activity
• There are three anatomic areas that thoracic outlet obstruction can occur in:
  • Scalene Triangle
    1. Most common site of neurogenic
  • Costoclavicular space
    1. Most common site of venous
  • Pectoralis minor space
    1. Most common site for arterial

• There are several bedside maneuvers you can perform to help distinguish between these types