The symptoms of TOS are the result of compression to the brachial plexus, the subclavian artery and veins as they go through narrow passageways extending from the base of the neck to the axilla (armpit) and arm.ĭifferent forms of thoracic outlet syndromes TOS also includes the scalene/scalenus entrapment syndrome caused by the hypertonic anterior scalenus or scalene muscle compressing the brachial plexus and subclavian artery against the first thoracic rib. TOS comprises a group of diverse disorders that involve the compression of the nerves, arteries and veins in a region enclosed between the lower neck and the upper chest. The thoracic outlet is the anatomical area situated in the lower neck defined as a set of three spaces between the clavicle and the first rib, through which several important neurovascular structures as outlined above. The main veins of the shoulder, upper arm, elbow and forearm are the cephalic vein, the basilic vein, and the brachial vein, which drain the blood from multiple veins of the hand and forearm. As it descends along the upper limb, the subclavian artery branches into the axillary artery that turns around the humeral head and the deep brachial artery that runs along with the deeper structure of the arm, to then split into the major arteries of the forearm, the radial and ulnar arteries. The artery supplying the upper limb arises from the aorta and is called the subclavian artery. The main nerves of the shoulder / upper extremities are the axillary nerve, and the median, radial and ulnar nerves. From here they interchange and extend along the shoulder, the upper arm and forearm distally to the hand and fingers. The brachial plexus is a bundle of nerves originating from the spinal cord, which exit the vertebrae of the cervico-thoracic spine (C5 to T1) and descending along the body to form the brachial plexus.
In order to understand this pathology, we provide some anatomical descriptions. It was only years later at the medico-legal examination that TOS was finally identified and treated allowing the patient to regain work capacity. In addition, we will present a specific case study to illustrate the roller coaster of an individual who suffered a significant impairment of the function of the upper limb. In this newsletter together with Mr Thomas Kossmann, who has himself identified several TOS cases in his medico-legal work, we will provide a brief overview of the pathological characteristics of TOS. In compensable circumstances, the condition may also attract a permanent impairment value.
#Thoracic outlet syndrome armpit pain full
With a delayed diagnosis, the patient’s condition may become so severe that a full recovery is unachievable because a sustained TOS can cause irreparable damage to the nerves of the brachial plexus. The treatments offered are often unnecessary, bringing no benefit to patients who frequently develop significant mental health disturbances. TOS patients can be subjected over months or years to unnecessary tests and specialist examinations without a conclusive diagnosis. In fact, the diagnosis of TOS is generally dependent on the clinician’s familiarity with the complexity of TOS, taking into account the symptoms as well as the patient-specific risk factors. TOS is not easy to recognise, diagnose and treat, often resulting in a patient’s prolonged suffering before the condition is finally identified.
Thoracic outlet syndrome (TOS) is a critical condition both in medicine and within the medico-legal setting.
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