Neurogenic TOS

• Thoracic outlet syndrome - Neurogenic Classification:

  • pain distribution can be varied
  • Commonly occurs in neck, trapezius, arm and can refer to the chest and occipital headache
  • Pain present during activities and at rest
  • Paraesthesia spread in the upper limb and fingers
  • Variable pattern of weakness and heaviness affecting a specific muscle group
• Thoracic outlet syndrome - Neurogenic Classification:

  • Lower plexus (C8 - T1) – symptoms in the ulnar forearm, hand, axilla and anterior shoulder region
  • Upper plexus compression (C5 - C7) radiations to the chest, periscapular region, head and radial nerve distribution
  • Need to differentiate if referral from cervical spine or TOS - cervical spine movements shouldnt aggravate TOS symptoms when doing active and passive movements and PAIVMS
  • Can mimic features of carpal tunnel syndrome and cubital tunnel syndrome - need to differentiate
• Neurogenic Thoracic outlet syndrome - Objective:

  • Tenderness on palpation through scalene triangle and subcoracoid space
  • Upper Plexus (C5 - C7)
  • Sensory disturbance of the upper arm
  • Weakness/atrophy of deltoid, biceps and brachialis
  • Lower Plexus (C8 - T1)
  • Sensory changes in ulnar border of forearm and into the hand
  • Weakness/atrophy of small muscles of the hand, weak wrist finger flexion
  • Objective tests:
  • Positive results on EAST, NTPT and Adsons test
  • Neural integrity assessment is required!