Arterial TOS

• Thoracic outlet syndrome - Arterial Classification:

  • Can develop secondary to repetitive upper limb activities leading to claudication - reduction in blood flow (Hooper et al., 2010)
  • Present with non-radicular pattern of pain and numbness of the upper limb
  • prominent features: numbness, coolness and pallor
  • Key distinguishing feature compared to NTOS is the lack of symptoms in the shoulder or neck
  • Claudication can occur during activity and at rest
  • Exacerbated by elevation of arms above head
  • Usually occurs through compression of the subclavian artery by the cervical rib
• Arterial Thoracic outlet syndrome - Objective:

  • Raynauds phenomenon - lack of blood flow, so fingertips go white, then cyanosis occurs, but then theres a return of blood flow - causes redness and tingling
  • Vascular changes: upper limb ischaemia, digital ulceration,
  • Sensory disturbance of the upper arm
  • Weakness/atrophy of deltoid, biceps and brachialis
  • Objective tests:
  • Positive results on EAST (Roos), NTPT, Adsons test
  • Blood pressure differential more than 20mmHg between arms
  • Neural integrity assessment is required!