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Thoracic outlet syndrome
Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and the subclavian artery and vein blood vessels between the base of the neck and axilla (armpit).
Additional recommended knowledge
For the most part, these disorders are produced by compression of the components of the brachial plexus (the large cluster of nerves that pass from the neck to the arm), the subclavian artery, or the subclavian vein. These subtypes are referred to as neurogenic TOS, arterial TOS, and venous TOS, respectively. The compression may be positional (caused by movement of the clavicle and shoulder girdle on arm movement) or static (caused by abnormalities or enlargement of the various muscles surrounding the arteries, veins and brachial plexus).
The neurogenic form of TOS accounts for 95 to 98% of all cases of TOS.
It is known from pathological studies of cadavers, and from surgical studies of patients with TOS, that there are numerous anomalies of the scalene muscles and the other muscles that surround the arteries, veins and brachial plexus. TOS may result from these anomalies of the scalene muscles or from enlargement (hypertrophy) of the scalene muscles. One common cause of hypertrophy is trauma, as may occur in motor vehicle accidents.
The two groups of people most likely to develop TOS are those suffering neck injuries in motor vehicle accidents and those who use computers in non-ergonomic positions for extended periods of time, especially for their occupation.
The following taxonomy of TOS is used in ICD-9-CM and other sources:
Only a few patients require surgical decompression through either removal of the upper rib, muscle scraping, or scar tissue. Often, continued and active postural changes along with physiotherapy or osteopathy will suffice. The recovery process however is long term, and a few days of poor posture can often set one back.
Surgical approaches have also been proposed.
Major League Baseball players Hank Blalock and Kenny Rogers have recently been diagnosed with Thoracic outlet syndrome. Kenny Rogers was diagnosed several years earlier with TOS in the other upper extremity. All-Star pitcher J. R. Richards suffered a career-ending stroke from an undiagnosed case of TOS. Pitcher David Cone had a variant case of TOS, with an arterial aneurysm of the upper aspect of his pitching arm.
Overhead athletes, such as swimmers and volleyball players, are known to be predisposed to the development of TOS.
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Thoracic_outlet_syndrome". A list of authors is available in Wikipedia.|