Thoracic outlet syndrome is a constellation of signs and symptoms resulting from compression of either a nerve or a blood vessel in the neck, just as it exits the spinal cord. There are several possible sites of compression. The most common locations is between the anterior and middle scalene muscles. However, the nerves may also be compressed under a cervical rib, or under the pectoralis minor muscle. The compression may be related to a nerve or a blood vessel, in which case it is classified as neurogenic or vascular, respectively. Neurogenic thoracic outlet syndrome is typically treated by a surgeon trained in hand and microsurgery, while vascular thoracic outlet syndrome is typically treated by a vascular surgeon.
Patients with TOS typically complain of pain around the neck that radiates into the fingertips. Although any of the fingertips can be affected, the most common are the small and ring fingers.
The diagnosis of TOS is usually made through physical exam findings and history. The examiner may order electrodiagnostic studies to evaluate the nerves for other more common sites of nerve compression.
