Thoracic Outlet Syndrome
What is it: Thoracic outlet syndrome is caused by a compression of the brachial plexus or subclavian vessels as they exit the neck into the shoulder region and pass under the first rib.
How does it present: Symptoms vary and are often difficult to differentiate from other shoulder etiologies such as rotator cuff pathology or cervical radiculopathy. Patients may complain of diffuse neck and shoulder pain, paresthesias or arm swelling (if there is vascular compromise). Arm pain may be worse with the arm elevated. Thoracic outlet syndrome must be differentiated from more serious conditions such as brachial plexus neuritis and pancoast tumors.
Common exam findings: Symptoms may increase with overhead ranges of motion on exam. You may also have a positive Costoclavicular Maneuver, Roos' Test, or Adson's Test.
Tests and treatment: If you suspect thoracic outlet syndrome, you may consider cervical spine films to evaluate for the presence of a cervical rib, or prominent C7 transverse process that may be contributing to the symptoms. Additional tests (e.g., MRI, EMG) can be used to rule out other causes.