Skip to Main Content

+

  • • Variety of disorders caused by arterial, venous, or neural compression at base of neck

    • Mechanical causes for compression include:

    • -Cervical rib

      -Anomalous ligaments

      -Anterior scalene hypertrophy

      -Positional changes with relation to first rib

    • Patients may describe history of cervical trauma

    • Symptoms rare prior to adulthood, suggesting alteration of normal structure with age is cause

    • Subclavian artery stenosis: Arterial stenosis and poststenotic dilation

    • Subclavian vein compression: Can lead to effort thrombosis (Paget-Schroetter)

++

Epidemiology

+

  • • Prolonged hyperabduction in hairdressers, painters, truck drivers

++

Symptoms and Signs

+

  • • Neurologic symptoms predominate

    • Pain, paresthesias, numbness in brachial plexus trunks (ulnar most common)

    • Hand numbness often wakes patients from sleep

    • Motor deficits indicate long duration

    • Muscular atrophy of hand may be present

    • May be reproducible on exam with various maneuvers of shoulder girdle

    Adson test: Weakened radial pulse with arm abduction and head rotated to opposite side

    Tinel test: Light percussion in supraclavicular fossa produces peripheral sensations

    • Venous compression and arterial compression less common

    Subclavian artery compression: Bruit, distal emboli, or arterial occlusion

    Subclavian vein compression: Thrombosis of vein leading to extremity pain and swelling (effort thrombosis called Paget-Schroetter syndrome)

++

Imaging Findings

+

  • • Cervical x-ray may identify cervical rib

+

  • • No objective study to confirm diagnosis of neurogenic thoracic outlet syndrome

++

Rule Out

+

  • • Carpal tunnel syndrome

    • Cervical disk disease

+

  • • Cervical x-ray and electromyography to rule out other causes of neurologic syndrome

    • Arterial syndrome: Angiography

    • Venous syndrome: Venography

+

  • • Postural correction and physical therapy

    • If surgical repair warranted, thoracic outlet decompression

    • 2 approaches possible

    • 1. Supraclavicular

      2. Transaxillary

    • Goals:

    • -Excise anterior scalene and fibrous bands

      -Rib resection

    • Arterial disease: Thoracic decompression and arterial reconstruction

    • Venous disease: First treat with thrombolytics or anticoagulation, then thoracic outlet decompression, may need venous reconstruction (open or endovascular)

++

Surgery

++

Indications

+

  • • Arterial disease

    • Venous disease

    • Neurologic symptoms not attributable to other disease and failure of conservative therapy after 3-6 months

++

References

Sharp WJ et al. Long-term follow-up and patient satisfaction after surgery for thoracic outlet syndrome. Ann Vasc Surg. 2001;15:32.  [PubMed: 11221941]
Kreienberg PB et al. Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter syndrome. J Vasc Surg. 2001;33:5100.
Schneider DB et al: Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intra-operative angioplasty. J Vasc Surg 2004;40:599.  [PubMed: 15472583]

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.