Thoracic Outlet Syndrome Testing: A Comprehensive Overview

Thoracic outlet syndrome (TOS) is a rare pathology characterized by compression of the nerves and blood vessels in the thoracic outlet, which connects the neck and shoulder regions. The diagnosis of TOS can be clinical or instrumental, involving various tests to identify the cause of compression.

One of the primary tests for diagnosing TOS is the Adson test, where the arms are raised to 90° to accentuate arterial and/or venous compression symptoms. This test is often performed in conjunction with ultrasound examination to measure changes in artery and subclavian vein caliber and flow.

Standard radiography is also used to determine the presence of cervical ribs, which can compress both the brachial plexus (neurological form) and the subclavian artery (vascular form). Compression of the subclavian vein by hypertrophy of the anterior scalene muscle is another common manifestation of TOS.

The incidence of TOS is higher in females aged between 20 and 50, with bilateral compression being relatively rare due to the coexistence of two cervical ribs and bilateral hypertrophy of the scalene muscles. While a congenital alteration, cervical ribs can be asymptomatic or cause symptoms such as tingling, paresthesia, hypo-perfusion, and cyanosis.

In some cases, TOS may be caused by acquired conditions like hypertrophy of the scalene muscles, which is often seen in athletes who engage in sports that involve shoulder movements. This type of compression typically affects the subclavian vein, leading to venous stasis with hypertension, swelling, pain, and cyanosis.

Overall, a comprehensive understanding of TOS testing is crucial for accurate diagnosis and effective treatment. By recognizing the various signs and symptoms, healthcare professionals can develop personalized treatment plans to alleviate compression and restore normal blood flow and nerve function.

Thoracic outlet syndrome testing