Shoulder disorders or complaints are very common in a sports medicine practice.
Shoulder disorders or complaints are very common in a sports medicine practice. An unusual cause that can require a high index of suspicion is thoracic outlet syndrome. Thoracic outlet syndrome, otherwise known as TOS, constitutes a group of disorders that results in compression of the neurovascular bundle exiting the anatomic thoracic outlet.
Around 90-95 percent of thoracic outlet syndrome is caused by nerve compression or neurogenic thoracic outlet syndrome. The other roughly five to ten percent of cases is caused by compression of either arteries or veins, or vascular thoracic outlet syndrome. It can affect both the athletic population and the general population, but is more common in occupations that require manual labor or repetitive lifting motions.
The thoracic outlet is an anatomical area in the lower neck and is defined by three spaces between the clavicle and first rib in which several neurovascular structures pass. These structures include the brachial plexus, subclavian artery and subclavian vein. The first or most proximal is the interscalene triangle, which is bordered by the scalenes and the first rib inferiorly.
The trunks of the brachial plexus and subclavian artery are located in this triangle. The second, the costoclavicular triangle is bordered anteriorly by the middle third of the clavicle, posteromedially by the first rib, and posterolaterally by the upper border of the scapula. The third narrow area is the subcoracoid space beneath the coracoid process, also known as the pectoralis minor space.
Thoracic Outlet There can be many causes of compression of the neurovascular bundle. Congenital abnormalities such as the cervical or rudimentary first rib and prolonged transverse processes are asymptomatic in most people, but have been shown to be a predisposing factor. Fibrous bands or anomalies in the trasversocostal, costocostal area are reported along with muscular anomalies such as a scalenus anticus muscle or sickle shaped scalene medius muscle.
If you are experiencing symptoms that may be related to vascular thoracic outlet syndrome, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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