Anterior scalene blocks (diagnositic and prognostic).EMG/Nerve Conduction studies (median antebrachial cutaneous nerve).U/S for Venous TOS – (92% Specificity, 95% Sensitivity) (6).CT/MRI – Space occupying lesions, post-traumatic deformity, soft-tissue anomalies.CXR – Cervical ribs, C7 Transverse processes, shoulder girdle abnormalities (5).Loss of pulse results in a positive test. +ve test is loss of pulse.įigure 3 – Roos Test: Patient is asked to hold flexed pose, inability to hold pose on affected side represents a positive test.įigure 4 – Adson test: Patient’s arm is held in extension and 30 deg of abduction with head turned towards/ispilaterally to affected arm. None available – likely secondary to differing definitions sitedĬlassic patient, young thin female, forward posture with neck flexion and anteriorly located glenohumeral joint (1)ĩ0% Neurogenic, 3% Venous, 20 between arms, upper extremity, chest wall congestionįigure 2 – Allen test/Wright Test :Arm abducted and in posterior scaption, with head turned in contralateral direction to tested side. Costocoracoid ligament – implicated in Paget-Schroetter Syndrome, venous TOS with thrombosis.
Scalenous Minimus accessory muscle, found in 30-50% of TOS patients.2nd most common site of neurovascular compressionĬombination of genetic predisposition and trauma – acute or chronic/repetitiveĪnatomic predisposition separated into Soft tissue (70%) and Osseous Abnormalities (30%) (2) Pectoralis minor space – Area between Pec minor and chest wall.Costo-clavicular space – Area between first rib and clavicle.Cervical and anomalous rib compression point Bounded by Anterior/Middle Scalene and first rib. Scalene Triangle – Most common site of brachial plexus compression.Neurovascular Compression in 3 possible spaces Cluster of Neurogenic or vascular symptoms caused by the compression of the neurovascular bundle at the thoracic outlet (1)Ĭervical rib syndrome, Scalene Anticus syndrome, Costoclavicular syndrome, Hyperabduction syndromeīoundaries of Thoracic Outlet – Spinal Column, First Rib, Sternum
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