Thoracic outlet syndrome (TOS) in its simplest form is postural compression of the subclavian artery causing relative ischaemia of the upper limb presenting as fatigue, claudication and pallor usually with overhead activity or caudal depression of the shoulder. The compression may become constant rather than postural, and the compression may involve the nerves of the brachial plexus rather than the artery. The classic neurological presentation is of compression of the lower roots or lower trunk of the brachial plexus presenting with severe ulnar neuropathy but including wasting of abductor pollicis brevis (the median nerve T1 innervated muscle) and including sensory disturbance of the medial forearm (the medial cutaneous nerve of the forearm arises proximally from the medial cord). However such obvious signs of severe neuropathy are very rare and usually the compression or irritation is mild, intermittent, postural, and proximal leading to ill-defined symptoms and signs. In these cases thoracic outlet syndrome is a frustrating condition to diagnose, leading many to ignore it or even refute its existence.
This chapter aims to assist in the diagnosis and treatment of thoracic outlet syndrome by explaining both the classic and difficult presentations of the syndrome, the examination manoeuvres, investigative techniques, the indications for surgery, the operative approach, outcomes and complications.
Aetiology Anatomy and biomechanics Clinical diagnosis and tests Complications Non-operative treatment Operative technique Operative treatment Results Thoracic outlet
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