A Comprehensive guide to Thoracic outlet syndrome (TOS)

(Koru Chiropractic, 2023)

(Physiotutors, 2024).

TOS describes a group of disorders that occur due to the compression of the brachial plexus, the subclavian vein and subclavian artery as they depart the thoracic outlet, which is the area between the clavicle and the first rib (Sanders et al., 2008; Watson et al., 2010). The thoracic outlet encompasses three anatomical areas including the interscalene triangle, the costoclavicular space and the subcoracoid space. (Jones et al., 2019).

There are three subsets of TOS, neurogenic, vascular, and arterial. Neurogenic TOS (nTOS) is the most common condition, accounting for 95% of cases. Vascular TOS (vTOS) contributes to 3-5% of cases, with arterial TOS (aTOS) responsible for the remaining 1-2%. TOS affects ~10% of the population and is 4-5 times more prevalent in women than men. 81% of cases occur in the patient’s dominant limb (Laulan et al., 2010). The impacts of TOS are multifactorial and reduce quality of life by hindering job performance causing feelings of isolation due to chronic pain (Buller et al., 2015).

This resource is imperative for new graduates transitioning into clinical practice because TOS is indiscriminate and nondescript, making accurate diagnosis and treatment extremely challenging in clinical populations (Jones et al., 2019). Furthermore, TOS is often misdiagnosed in practice as it shares overlapping symptoms with common conditions surrounding the neck, chest, and upper extremities, including cervical radiculopathy and carpal tunnel syndrome (Jordan, 2013).

TOS can be extremely dangerous if left undiagnosed or untreated, as previous cases have illustrated that the misdiagnosis of TOS has resulted in the occlusion of the subclavian artery, causing embolisms, chronic pain, and even permanent nerve damage (Balram et al., 2014; Kuhn et al., 2015). This in-depth guide will shed some light on TOS allowing for adequate assessment and treatment to avoid these complications. Despite its well-documented severity, TOS is often not a prominent topic in physiotherapy programs at Universities, leaving many students and new graduates unfamiliar with its diagnosis and management.