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FREE BOOK THORACIC OUTLET SYNDROME – Chapter II – The Anatomy of The Thoracic Outlet

 

You are reading Chapter II – The Anatomy of the Thoracic Outlet

FREE BOOK

THORACIC OUTLET SYNDROME

by Dr James Stoxen DC

Chapter II

The Anatomy of the Thoracic Outlet  


Table of Contents

Preface
Introduction
The Sonny Burke Story

Chapter I      What is Thoracic Outlet Syndrome? (TOS)
Chapter II     Anatomy 
Chapter III    The TOS Controversy
Chapter IV    History, Cause, and Patient Presentations
Chapter V     Physical Examination Findings
Chapter VI    Diagnostic Tests 
Chapter VII   Standard of Care Approaches – Surgical and Non-Surgical 
Chapter VIII  Frequently Asked Questions 
Chapter IX    Case Histories of Patients 
Chapter X     The Human Spring Approach to Treatment and Prevention


 Chapter II

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Anatomy of Thoracic Outlet Syndrome

 

Thoracic Outlet Syndrome – Three Potential Areas of Compression

     Thoracic outlet syndrome is the often misdiagnosed cause of neck pain, shoulder pain and arm disability. It is thought to be neurovascular compression seen at the thoracic outlet, which is something that anatomists can’t agree on. The actual name doesn’t properly describe the condition.

Thoracic Outlet Areas Of Compression

Thoracic Outlet Areas Of Compression

3 areas of potential regions of compression consisting of:

  1. The Inter Scalene Triangle
  2. The Costoclavicular Space
  3. The Intrapectoral Space

The Inter Scalene Triangle

This is bordered by the anterior and middle scalenes. The supraclavicular bundle consisting of the subclavian vein, the subclavian artery and the brachial plexus emanate from this triangle and it’s an area where any one of these structures can become compressed and cause symptomatology.

The Costoclavicular Space

The area below the clavicle and above the first rib represents the costoclavicular space. Few patients and doctors understand that the ribs actually go up this high at the face of the neck.

The Interpectoral Space

The last space is the interpectoral space and that is in the area of pectoralis minor and that area can be an area of compression.

Arteries, Veins and Nerves pass through the Thoracic Outlet

Doctors have to be aware of these multiple areas of compression and have an understanding of what symptoms can be related to each one of these areas so they can better treat the patient. The three-neurovascular structures that pass through the thoracic outlet area are the brachial plexus consisting of cervical nerves C5, C6, C7, C8 and T1. The subclavian artery is the artery that supplies the arm with blood, oxygen and nutrients. The subclavian vein drains the blood away from the arm and back to the heart.

What is Venous Thoracic Outlet Syndrome?

Venous thoracic outlet syndrome (TOS) is also known as Paget-Schroetter syndrome or subclavian vein effort thrombosis. Paget determined that the symptoms of the upper extremity (ie, arm swelling) were a result of subclavian vein thrombosis. Von Schroetter further proposed that the upper extremity venous symptoms were a result of thrombosis of the subclavian vein at the thoracic outlet. At the level of the thoracic outlet, the subclavian vein passes over the first rib, anterior to the insertion of the anterior scalene muscle. This space is called the costoclavicular space and is located between the clavicle and subclavius muscle, superior to the subclavian vein with the first rib being inferior to the subclavian vein.

Venous TOS is a result of extrinsic compression of the subclavian vein, which results in injury of the vein, and eventual, stenosis (narrowing) and thrombosis (clotting). The most common causes of extrinsic compression of the subclavian vein are a narrow costoclavicular space or muscular hypertrophy of the subclavius or anterior scalene.

A symptom of Venous Thoracic Outlet Syndrome is pitting edema of the arm

The symptoms of venous TOS are caused by subclavian vein thrombosis and/or stenosis. The symptoms involve the upper extremity (arm), and include: arm swelling, arm heaviness or aching of the arm, and cyanosis. An individual may notice prominent, distended veins in the upper chest and shoulder region as well as pitting edema of the arm (pictured above), distending veins and dilated collateral veins. Especially after activities which require repetitive use of the involved extremity.  Rarely, a pulmonary embolism may occur.

Paget–von Schrötter disease, is a form of deep vein thromboisis (DVT), in which blood clots form in the veins of the arms.  These DVTs typically occur in the axillary or subclavian veins.


 Read Chapter III – Thoracic Outlet Syndrome controversy


Thoracic Outlet Syndrome Book

 


 

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All content on teamdoctorsblog.com, including without limitation text, graphics, images, advertisements, videos, and links (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical treatment, advice, or diagnosis. Please remember to always seek the advice of a qualified physician or health professional with any questions you may have regarding any medical concerns. Dr James Stoxen DC and Team Doctors does not recommend or endorse any specific treatments, physicians, products, opinions, research, tests, or other information it mentions. Said Content is also not intended to be a substitute for professional legal or financial advice. Reliance on any information provided by Team Doctors is solely at your own risk.

About Dr James Stoxen DC (282 Posts)

Dr. James Stoxen, D.C., owns and operates Team Doctors Treatment and Training Center. and Team Doctors Sports Medicine and Anti-aging Products. He has been the meet and team chiropractor at many national and world championships. He has been inducted into the prestigious National Hall of Fame, the Personal Trainers Hall of Fame and appointed to serve on the prestigious, Global Advisory Board of The International Sports Hall of Fame. He is also a member of the Advisory Board for the American Board of Anti-Aging Health Practitioners. Dr. Stoxen is a sought after speaker, internationally having organized and /or given over 1000 live presentations around the world.(full bio)


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