![]() ![]() The subclavian vein has an identical course, except that it passes anteriorly rather than posteriorly to the scalenus anticus muscle. It then passes under the clavicle and finally enters the axilla beneath the pectoralis minor muscle. The subclavian artery leaves the thorax by arching over the first rib behind the scalenus anticus muscle (anterior scalene) and in front of the scalenus medius muscle (middle scalene). Thoracic outlet syndrome: evaluation of the therapeutic exercise program. Peet RM, Hendriksen JD, Anderson TP, et al. Knowledge of the thoracic outlet anatomy is fundamental to the diagnosis of any type of TOS. The thoracic outlet is the area between the neck and shoulder, over the top of the thorax, and under the clavicle to the axilla. ![]() Neurovascular compression in the thoracic outlet: changing management over 50 years. Thoracic outlet syndrome (TOS) refers to the compression of one or more of the neurovascular structures traversing the superior aperture of the chest. Surgical management of nerve compression is indicated in individuals who show physical signs of nerve damage or who have failed conservative treatments. Patients with venous or arterial occlusion require prompt evaluation for surgical intervention with thrombolysis and thoracic outlet decompression.įor most cases of disputed neurologic thoracic outlet syndrome, initial management is conservative and includes physical therapy. It usually occurs in the setting of congenital abnormalities of the thoracic outlet, hyperextension injuries, repetitive stress injuries (e.g., work related), and external compressing factors (e.g., poor posture). Neurologic TOS primarily develops spontaneously in people in their late teens up to the age of 60 years, and is more common in women. Neurologic is the most common, while arterial, which is relatively rare, is arguably the most important to recognize owing to the risk of ischemia. Types include neurologic, arterial, venous, and neurovascular/combined, and patients may present with signs and symptoms of nerve, vein, or artery compression or any combination of these. Thoracic outlet syndrome (TOS) may affect neurologic or vascular structures, or both, depending on the component of the neurovascular bundle predominantly compressed.
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