Epidemiology Thoracic outlet syndrome

Epidemiology Thoracic outlet syndrome

thoracic outlet syndrome TOS is a symptom complex characterized by pain, paresthesia, weakness and discomfort in the upper limb which is aggravated by elevation of the arm or by exaggerated movements of the head and neck.15
Incidence Incidence of TOS is reported to be approximately 8% of the population9 and is extremely rare in children10. In particular true neurological TOS is typically found in young woman.13
Prevelance According to Davidovic et al. 98% of all patients with TOS fall into the non-specific TOS category and only 2% have vascular TOS. 9
Sex Affects females more than males (between 4:1 and 2:1 ratios)9,11,12,14
Age TOS is most common between 20 and 40 years of age and is very rare in children.9,10
Pain location Upper limb; can give sensation in the shoulder, arm,hand and fingers.
Pain sensation / Symptoms Pain, paresthesia, weakness and discomfort in the upper limb
History of injury Young woman and woman that have big breasts have a higher risk of getting TOS. Protraction and depression of the shoulder joint can give a smaller costoclavicular space. Thoracic outlet syndromes can give neurological and vascular symptoms. TOS should only be given if all other pathology has been ruled out.2,3,4,5Reasons for TOS could be: Anatomical difference, Trauma, dislocation of scapula to posterior in the SC joint and more..

Sports involving weightlifting, rowing and/or swimming can cause a hypertrophic m.scaleni. the scalenus gate can get smaller in this case.1

Physical exam When testing for TOS, the purpose of testing is to get a lower heartbeat and reproducing the symptoms of the patient.6
Literature 1 “Compression and stretching of the brachial plexus in thoracic outlet syndrome: Correlation between neuroradiographic findings and symptoms and signs produced by provocation manoeuvres “, J. Ide, Y. Kataoka, M. Yamaga, T. Kitamura and K. Takagi, Kumamoto, Japan, 20032 Orthopedic Physical Assessment. D.J. Magee, p.199

  1. Roos DB: Congenital anomalies associated with thoracic outlet syndrome, J Surg 132:771-778, 1976.
  2. Liebenson CS: Thoracic outlet syndrome: Diagnosis and conservative management, J Manip Physiol Ther 11:493-499, 1988.
  3. Ribbe EB, Lindgren SH, Norgren NE: Clinical diagnosis of thoracic outlet syndrome: Evaluation of patients with cervicobrachial symptoms, Manual Med 2:82-85, 1986.
  4. Sallstrom J, Schmidt H: Cervicobrachial disorders in certain occupations, with special reference to compression in the thoracic outlet, Am J Ind Med 6:45-52, 1984.
  5. Wright IS: The neurovascular syndrome produced by hyperabduction of the arms, Am Heart J 29:1-19, 1945.
  6. Adson AW, Coffey JR: Cervical rib: a method of anterior approach for relief of symptoms by division of the scalenus anticus, Ann Surg 85:839-857, 1927.
  7. Davidovic LB, Kostic DM, Jakovljevic NS, Kuzmanovic IL, Simic TM. Vascular thoracic outlet syndrome. World Journal of Surgery 2003;27(5):545-50.
  8. Cagli K, Ozcakar L, Beyazit M, Sirmali M. Thoracic outlet syndrome in an adolescent with bilateral bid ribs. Clinical Anatomy 2006;19(6):558-60.
  9. Degeorges R, Reynaud C, Becquemin JP. Thoracic outlet syndrome surgery: longterm functional results. Annals of Vascular Surgery 2004;18(5):558-65.
  10. Demondion X, Bacqueville E, Paul C, Duquesnoy B, Hachulla E, Cotten A. Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations. Radiology 2003;227(2):461-8.
  11. van Es HW. MRI of the brachial plexus. European Radiology 2001;11(2):325–36.
  12. Gockel M, Vastamaki M, Alaranta H. Long-term results of primary scalenotomy in the treatment of thoracic outlet syndrome. Journal of Hand Surgery [Br] 1994;19(2):229–33.
  13. Lindgren KA, Oksala I. Long-term outcome of surgery for thoracic outlet syndrome. American Journal of Surgery 1995;169(3):358–60.

Leave a Reply