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Thoracic outlet syndrome (TOS) results from compression of the nerves, artery and vein which pass through the thoracic outlet (a space at the base of the neck between the first rib and muscles of the neck and chest). Each of these structures may be compressed separately or together and each gives a distinct presentation. Therefore TOS can present in three different forms. Compression of the nerves (neurogenic TOS), is the most common form, occurring in more than 95% of cases. Compression of the subclavian vein (venous TOS), occurs in 2-3% of cases and compression of the subclavian artery (arterial TOS), in 1%. There are a number of conditions that can cause thoracic outlet compression. Neck trauma can precipitate a change in neck muscles with subsequent development of TOS. The congenital presence of an extra rib or fibrous bands can lead to a severe form of TOS. The majority of patients with thoracic outlet syndrome are successfully treated conservatively. Only a small proportion will require surgery to relief the compression. |
