My boyfriend has been diagnosed with thoracic outlet syndrome can anyone give me some info about it?

What is the Thoracic Outlet?
The Thoracic Outlet is a space between the rib cage (thorax), and the collar bone (clavicle) through which the main blood vessels and nerves pass from the neck and thorax into the arm. The nerves and blood vessels leave the neck between the two muscles (scalene muscles).

What is a syndrome?
A syndrome is a set of symptoms and physical findings that point to a certain diagnosis. All the symptoms and physical findings are not always present.
Various symptoms and physical findings may be present in different grades of severity.

What is Thoracic Outlet Syndrome?
Thoracic outlet syndrome is a combination of pain, numbness, tingling, weakness, or coldness in the upper extremity caused by pressure on the nerves and/or blood vessels in the thoracic outlet.

What Causes Thoracic Outlet Syndrome?
There are several causes of TOS. The common underlying cause of the syndrome is compression of the nerves and arteries of the arm in the Thoracic Outlet. In some cases the cause of compression is evident- an extra first rib or an old fracture of the clavicle, which reduces the space of the outlet. In other cases the cause is not clear. Compression may occur with repetitive activities that require the arms to be held overhead.

Symptoms
Symptoms of TOS include pain, numbness and tingling, (pressure on sensory nerves) weakness and fatigue (pressure on motor nerves) or swelling and coldness in the arm and hand (pressure on blood vessels). The symptoms can mimic many other conditions, such as a herniated disk in the neck, carpal tunnel syndrome, and even bursitis of the shoulder. Thus this syndrome can be very difficult to diagnose.

Treatment
When an anatomic defect is obvious that constricts the outlet, (an extra rib, a broken collar bone) surgery can correct the problem. This is rare. Good posture and overall conditioning are very important in treating the rest. The length of time the arms are used in outstretched or overhead positions should be reduced and spaced. Taking frequent breaks, changing positions, and stretching are useful. A physical therapist or an occupational therapist can teach the exercises. A home program of exercise is essential and must be performed consistently to produce benefits. Symptoms often respond to an exercise program addressing a healthy posture and muscle balance. Stretching and strengthening can help achieve optimal posture. Obese patients should seek advise for safe weight loss. A work site specialist can evaluate your workplace to determine safe alignment, work site postures, and work-related furniture. Women with large, pendulous breasts may benefit from a strapless long-line bra. Surgery for Thoracic Outlet Syndrome is the last resort.
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http://www.emedicine.com/emerg/topic578....
http://www.medschool.lsuhsc.edu/neurosur...
Definition Return to top

Thoracic outlet syndrome is a condition characterized by pain in the neck and shoulder, numbness/tingling of the fingers, and weakening of the grip.

Causes, incidence, and risk factors Return to top

Thoracic outlet syndrome is a rare condition caused by compression of blood vessels and nerves in the area of the clavicle (collar bone). This compression usually is caused by the presence of an extra cervical rib (above the first rib) or an abnormal tight fibrous band connecting the spinal vertebra to the rib.

People with long necks and droopy shoulders may be predisposed to develop this condition because of extra pressure on their nerves and blood vessels.

Symptoms Return to top

The following symptoms may indicate thoracic outlet syndrome:

Discomfort in the last 3 fingers (middle, ring, and pinky) and inner forearm
Numbness
Pain
Tingling
Pain and tingling in the neck and shoulders (may be worsened by carrying something heavy, such as a suitcase)
Weakness and wasting of the muscles of the hand
Signs and tests Return to top

Upon lifting, the arm may appear pale due to compression of the blood vessels. The arm may be smaller on the side of the symptoms, as this is often a congenital anomaly (present since birth).

Tests to confirm the diagnosis include the following:

X-ray (may reveal an extra rib)
MRI (may reveal fibrous band)
Nerve conduction velocity study
Electromyography (EMG)
Treatment Return to top

The syndrome is generally treated conservatively, with physical therapy to strengthen the shoulder muscles, improve range of motion, and promote better posture, as well as with analgesics or other pain medications.

Surgery is used as a last resort, but can be effective in select cases. Your doctor may suggest other alternatives.

Expectations (prognosis) Return to top

If selected carefully, patients undergoing removal of the fibrous band may have resolution of their symptoms. Conservative approaches using physical therapy are helpful in many patients.

Complications Return to top

Complications can occur with any surgery and relate to the particular procedure and anesthesia used.
http://www.nlm.nih.gov/medlineplus/ency/...
Background: Thoracic outlet syndromes are due to the compression of the neurovascular structures passing through the thoracic outlet. The syndromes can be classified into 3 subgroups based on the neurologic or vascular structure involved. The specific clinical presentations, demographics, treatments, and outcomes vary among the subgroups.

Subgroup 1, or the neurologic type, is the most common, and it is responsible for approximately 95% of cases of thoracic outlet syndrome. This type is secondary to compression of the brachial plexus caused by various soft tissue and bony abnormalities where the nerves pass between the anterior and middle scalene muscles. For a discussion of the neurology of this syndrome, see Thoracic Outlet Syndrome in the Neurology section of the journal.

Subgroup 2, the venous type, is the more common of the vascular causes and is seen in approximately 3-4% of patients with thoracic outlet syndrome. Venous thrombosis may be categorized into primary and secondary kinds, based on the etiology. Primary venous thoracic outlet syndrome, or primary venous thrombosis, is also called Paget-Schr枚tter syndrome. The disease is named after the 2 individuals who first described this entity: Paget, who described it in 1875, and von Schr枚tter, in 1884. Other terms for this condition include effort thrombosis, spontaneous thrombosis, and traumatic thrombosis.

Subgroup 3, or the arterial type of vascular causes, is the least common form of thoracic outlet syndrome and is seen in approximately 1-2% of patients. This type is associated with the most serious complications, including limb ischemia, which may result in the loss of the affected upper extremity.

Rarely, compression of a combination of structures may be responsible for the symptoms. This article is limited to the vascular causes of thoracic outlet syndrome.


Pathophysiology: Compression of the vascular structures passing through the thoracic outlet may occur at several anatomic sites and includes the following: (1) compression of arteries or veins medial to the scalene triangle in the costoclavicular space or beneath the pectoralis minor tendon in the axilla, (2) arterial compression within the scalene triangle itself, and (3) venous compression between the anterior scalene muscle and the clavicle. The relatively small size of these spaces, the hypertrophy of muscles around these spaces, congenital abnormalities, and pathologic masses (eg, tumors or callous formation) may all cause compression of adjacent vascular structures.

Arterial causes

The essential mechanism of subclavian artery thoracic outlet syndrome is chronic compression that results in intimal injury with fibrosis; thickening of the wall; and eventually, luminal narrowing. Poststenotic dilation develops as a result of hemodynamic turbulence distal to the site of narrowing. Distal thromboembolism is a severe complication that may result either from mural thrombus originating within the area of poststenotic dilation or from an intimal lesion at the site of compression with resultant formation of platelet aggregates. These platelet aggregates may microembolize distal to the small vessels of the hands and fingers, resulting in ischemia with eventual tissue necrosis.

Mural thrombi typically result in the occlusion of more proximal arteries with larger collateral supplies; therefore, these thrombi are less likely than the others to produce severe ischemic changes. Rarely, occlusion of the subclavian artery may occur. The most common cause of subclavian artery compression is a cervical rib, which is seen in 50% of cases. A cervical rib can posteriorly compress the subclavian artery at the scalene triangle against the anterior scalene muscle and first rib.

Other etiologies include congenital first-rib anomalies, first-rib exostoses, and malunited fractures of the clavicle. Rare causes include congenital fibromuscular bands and anterior scalene muscle anomalies.

Venous causes

Primary venous thrombosis is most likely to be related to a multifactorial etiology, including extrinsic compression or trauma with a congenitally narrow thoracic inlet. Chronic extrinsic compression may be caused by anatomic anomalies, such as a cervical rib, the first rib, hypertrophied subclavius or anterior scalene muscles, or a malunited clavicle fracture with abundant callous formation. Compression may be exaggerated when the upper extremity is in certain positions, such as in the rigid military style of sitting with the back straight and the shoulders placed posteriorly and inferiorly.

With chronic irritation of the vessel walls, these anomalies may predispose an individual to stasis, intimal damage, and hypercoagulability, which form a constellation of pathophysiologic events called the Virchow triad. At least 2 of these 3 factors are typically found in patients with primary venous thrombosis. The eventual result is the formation of an intraluminal thrombus, which causes the lumen to become narrowed and possibly entirely occluded. Most authors classify the anatomic causes of axillosubclavian vein thrombosis as primary. However, the etiology is investigated in all patients, and as the body of knowledge of causes of venous thrombosis improves, the label of primary venous thrombosis is slowly falling out of favor.

Secondary venous thrombosis has a number of causes, including the following:


Injury to the venous intima

Venous foreign bodies

Central venous catheters (most common cause)

Pacemaker wires

Traumatic injury

Fracture to rib or clavicle

Blunt or penetrating injury

External compressive force

Tumors (thoracic, cervical, axillary)

Substernal goiter

Inflammatory diseases

Thrombophlebitis of ipsilateral upper extremity

Infections in chest or neck

Fibrosing mediastinitis

Radiation therapy

Periphlebitis

Systemic disorders

Nephrotic syndrome

Extreme dehydration or shock

Congestive heart failure

Hypercoagulable states (polycythemia vera)

Dysplastic valve
The most common cause of secondary venous thoracic outlet syndrome is central venous catheter placement.

Other causes

Intraluminal foreign bodies often result in intimal injury; the incidence increases with the size of the object. As in primary venous thrombosis, this predisposes the individual to the formation of a thrombus.

Radiation therapy is known to cause arterial occlusion, and several studies have been performed to investigate the occurrence of venous thrombosis after radiation therapy. Wilson reported findings in 2 patients with breast cancer who were treated with tamoxifen and radiation therapy, with ipsilateral arm swelling 3 or 4 years after therapy. Venography revealed subclavian vein thrombosis in both patients.

Schreiber and Kapp reviewed findings in 225 patients who underwent combined chemotherapy and mantle radiation therapy for mediastinal lymphoma. They identified 4 patients with posttreatment subclavian vein thrombosis, of whom 3 received chemotherapy in the same arm as the venous thrombosis. Their observation suggests that the chemotherapeutic agent is a potential factor.

Malignant tumors have also been associated with venous thrombosis, and at least 2 mechanisms (direct venous compression and transitory migratory thrombophlebitis) have been postulated; both may exist simultaneously.


Frequency:


In the US: Of the vascular causes of thoracic outlet syndrome, the venous type is more common and occurs in approximately 3-4% of patients, whereas the arterial type is seen in approximately 1-2% of patients.
Internationally: Although the international demographic data regarding thoracic outlet syndrome are limited, data from Europe indicate that the incidence of arterial and venous thoracic outlet syndrome is similar to that of the United States.
Mortality/Morbidity:

Arterial thoracic outlet syndrome may result in ischemic signs and symptoms ranging from Raynaud phenomenon to gross digital ischemia.
The venous variant, if left untreated, usually results in swelling and a bluish discoloration of the entire affected arm.
Race: No racial predilection exists.

Sex: Thoracic outlet syndrome is traditionally more common in women than in men, although recent authors report a higher frequency in women, with a female-to-male ratio as high as 3:1.

Age: Thoracic outlet syndrome is most common in those aged 10-50 years.

Anatomy:

Arteries

The right subclavian artery arises from the innominate artery, which is the first major branch of the aortic arch. The left subclavian artery arises directly from the aortic arch as the final major branch. After leaving the thoracic cavity posterior to the sternoclavicular joint and arching over the pleural cupola, the subclavian artery passes through the scalene triangle, which is formed by the first rib inferiorly, the anterior scalene muscle anterolaterally, and the medial scalene muscle posteromedially. The artery then continues under the clavicle and subclavius muscle and enters the axilla, where it is renamed the axillary artery.

After passing inferior to the pectoralis minor muscle tendon, the artery is called the brachial artery, which continues distally along the medial aspect of the humerus. After occlusion of the subclavian artery, the blood supply to the peripheral arm is maintained by the collateral vessels present among the suprascapular, circumflex scapular, subscapular, and posterior circumflex humeral arteries as well as between the transverse cervical and posterior circumflex humeral arteries.

Veins

Superficial veins along the ulnar aspect of the arm drain into the median antebrachial and median antecubital veins, which in turn drain into the basilic vein. The basilic vein becomes the axillary vein after joining with the brachial vein. The radial aspect of the arm is drained by the cephalic vein, which passes along the deltopectoral groove lateral to the clavicle, and joins the azygous vein. At the outer border of the first rib, the axillary vein becomes the subclavian vein, which passes through the costoclavicular space. The first rib and anterior scalene muscles are positioned posteriorly, and the clavicle and subclavius muscle are positioned anteriorly. This path is unlike that of the subclavian artery, which is posterior to the anterior scalene muscle.

Clinical Details:

Arterial thoracic outlet syndrome

The most common initial clinical sign of arterial thoracic outlet syndrome is ischemia of the affected arm resulting from distal embolization. The site of ischemia depends on the size of the emboli. Microembolization of the arteries of the fingers and digital arch may result in ischemic signs and symptoms ranging from Raynaud phenomenon to gross digital ischemia.

Arterial thoracic outlet syndrome infrequently appears prior to the onset of acute upper extremity ischemia. Occasionally, neurologic symptoms resulting from a bony abnormality, such as a cervical rib, may occur before the onset of signs and symptoms secondary to arterial ischemia.

A subclavian artery aneurysm may be detected as a palpable mass during routine physical examination, or a cervical rib may result in anterior and superior displacement, which results in prominence of the subclavian artery.

All patients with upper extremity ischemic symptoms require a thorough evaluation for possible embolic sources, including a complete vascular examination. During the examination, the contralateral arm should be checked because evidence of bilateral upper extremity ischemia supports a central thromboembolic source, such as the heart. In particular, arterial thoracic outlet syndrome should be considered in a young patient with upper extremity ischemic symptoms. The patient should be asked about a history of trauma to the upper body with a healed fracture of the clavicle or upper ribs. Previous chest radiographs or other radiologic studies of the upper body should be reviewed to search for a cervical rib or other bony abnormality.

Venous thoracic outlet syndrome

With primary venous thoracic outlet syndrome, male patients are typically affected more often than female patients, with a ratio of 3:2 or 4:1 depending on the author.

The right upper extremity is affected more often than the left upper extremity.

Symptoms commonly begin within the first 24 hours in primary venous thrombosis, although, in some patients, symptoms may be insidious at the onset of thrombosis. Patients are usually aged 20-50 years and otherwise healthy.

Secondary venous thrombosis, unlike the primary variant, typically occurs in older patients and has a more uniform sex distribution. The most common symptoms of subclavian or axillary venous thrombosis include swelling, discoloration, collateral vein dilatation, and aching. Secondary venous thrombosis tends to develop gradually, with a relative delay in the clinical presentation and, therefore, in treatment. Initial symptoms may range from minor discomfort, aching, or weakness, to severe pain. Over time, the hand and forearm become cold to the touch, with diminished finger movements. Untreated, this condition eventually results in swelling and bluish discoloration of the entire affected arm.

Signs of secondary venous thrombosis during physical examination are typically more prominent in the distal structure; with the fingers and dorsal aspect of the hand having the most severe findings. Pitting edema, bluish discoloration, and coolness to the touch may be present. Distension of the venous system of the arm is also common, with the basilic and cephalic veins distension occurring first, followed by generalized distension of the remaining veins and venules.

On examination, the distended veins feel tense and do not collapse with abduction of the arm to above the level of the right atrium. In approximately one half of patients, the axillary vein is palpable as a cordlike mass in the lateral aspect of the axilla. In addition, supraclavicular tenderness may indicate extension of thrombus into the subclavian vein, which is a common finding. Further extension into the internal jugular vein or superior vena cava may result in swelling of the face and neck, which is similar to the findings of superior vena cava syndrome. During the following weeks, as further collateral pathways form between the axillary and cephalic veins to the mediastinal and intercostal veins, collateral veins may become visible over the upper part of the chest and the shoulder. These veins may allow adequate drainage of the affected extremity and, thus, improvement or resolution of the symptoms.

Preferred Examination: Various examination techniques can be used to distinguish among the etiologies of the thoracic outlet syndromes.

Findings of the Allen maneuver, the hyperabduction maneuver, are considered positive when the radial pulse disappears during extreme abduction of the arm. However, this finding is also present in individuals who do not have thoracic outlet syndrome and in individuals with asymptomatic cervical ribs; therefore, this finding is not diagnostic.

A positive Adson finding occurs when the radial pulse is reduced or disappears or when the patient's blood pressure changes when the patient (1) is in a sitting position, (2) holding a deep inspiration, (3) fully extending the neck, and (4) turning the head toward the ipsilateral and contralateral sides. Some investigators believe that the cause of these findings is compression by the anterior scalene muscle. A supraclavicular bruit may be audible with this maneuver and is believed to result from an associated subclavian stenosis.

The costoclavicular maneuver is performed when the patient assumes an exaggerated military posture and positions his or her shoulders back and downward; this positioning induces compression between the clavicle and the first rib.

Ultrasonography is readily available and relatively inexpensive, and it can be performed in both arterial and venous thoracic outlet syndrome. Magnetic resonance (MR) angiography and computed tomographic (CT) angiography of the thoracic inlet, especially with recently devised techniques and protocols, are promising noninvasive modalities that may soon provide image quality comparable to that of angiography and venography. Angiography and venography remain the criterion standards for the radiologic diagnosis of these conditions, and they have the added benefit of enabling potential endovascular treatment.

Limitations of Techniques: Despite considerable investigation to identify a clinical maneuver for the accurate diagnosis of vascular thoracic outlet syndrome, no clinical test has a consistently high degree of accuracy. The same positive findings are occasionally found in individuals without vascular thoracic outlet syndrome. Therefore, consider a positive result at clinical examination in context with the clinical history and the results of other diagnostic tests. The final diagnosis often depends on invasive procedures such as arteriography. MR angiography and CT angiography techniques are evolving, and, in the near future, they may be able to replace many of today's invasive diagnostic angiographic examinations.
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your welcom hope i was able to help you out any. and sorry to hear that ur boyfriend was diagnosed with tos it dont sound very nice
have a good day. Report It

Thoracic outlet syndrome is a combination of pain, numbness, tingling, weakness, or coldness in the upper extremity caused by pressure on the nerves and/or blood vessels in the thoracic outlet.

Also try looking at:

www.handsurgeon.com/
thoracic_outlet.html

www.ninds.nih.gov/disorders/
thoracic/thoracic.htm

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