Thoracic outlet syndrome
Encyclopedia
Thoracic outlet syndrome (TOS) is a syndrome involving compression at the superior thoracic outlet involving compression of a neurovascular bundle passing between the anterior scalene and middle scalene. It can affect the brachial plexus
(nerves that pass into the arm
s from the neck
), and/or the subclavian artery
or rarely the vein
which does not normally pass through the scalene hiatus (blood vessel
s as they pass between the chest and upper extremity). Rarely a Pancoast tumour in the apex of the lung may be the cause.
The compression may be positional (caused by movement of the clavicle
(collarbone) and shoulder girdle on arm movement) or static (caused by abnormalities or enlargement or spasm of the various muscles surrounding the arteries
, vein
s, and brachial plexus), a first rib fixation and a cervical rib.
Common orthopaedic tests used are the Adson's test, the CostoClavicular manoeuvre and the Hands-Up test of East. Careful examination and X-ray are required to differentially diagnose between positional and static aetiology, first rib fixations, scalene muscle spasm and a cervical rib or fibrous band.
One cause of arterial compression is trauma
, and a recent case involving fracture of the clavicle has been reported
The two groups of people most likely to develop TOS are those suffering from neck injuries from traffic collisions and those who use computers in non-ergonomic postures
for extended periods of time. It is a frequent repetitive stress injury caused by certain types of work environments. Other groups which may develop TOS, are athletes who frequently raise their arms above the head (such as swimmers, volleyball
players, shuffle
players, baseball pitchers, and weightlifters), rock climbers, electricians who work long hours with their hands above their heads and also some musician
s.
Some people are born with an extra, incomplete and very small rib above the first rib, which protrudes out into the superior thoracic outlet space and this rib causes fibrous changes around the brachial plexus nerves and causes the symptoms of Thoracic Outlet Syndrome. This is called a Cervical Rib, and is attached to the C-7. The symptoms of Thoracic Outlet Syndrome can first appear in the early teen years as a child is becoming more athletic. Surgical removal of this rib is almost always recommended.
TOS is often the underlying cause of stubborn upper limb conditions like frozen shoulder and carpal tunnel syndrome that defy standard treatment protocols.
Cerebrovascular arterial insufficiency when they affect the subclavian artery. It also can affect the vertebral artery, case in which it could produce transient blindness, and embolic cerebral infarction.
A painful, swollen and blue arm, usually occurring after strenuous physical activity, could be a sign of a venous compression or subclavian vein thrombosis, called Paget-Schroetter Syndrome.
and the costoclavicular maneuver are notoriously inaccurate, and may be a small part of a comprehensive history and physical examination of a patient with TOS. There is currently no single clinical sign that makes the diagnosis of TOS with certainty.
Additional maneuvers that may be abnormal are the stick em up "hand raise" for up to 3–5 minutes (holding both hands at right angles bent at the elbows over head, with or without hand opening and closing fingers, the affected hand will often quickly become paler than the unaffected because of compromised blood supply) and the "compression test" (pressure between the clavicle and medial humeral head causes radiation of pain / numbness into the affected arm).
MRI/MRA Special high resolution MRI/MRA of the Brachial Plexus
Some physicians advocate the injection of a short-acting anesthetic such as xylocaine or marcaine into the anterior scalene, subclavius, or pectoralis minor muscles as a provocative test to assist in the diagnosis of thoracic outlet syndrome. This is referred to as a 'scalene block' with the use of Lidocaine or similar drug. However, this is not considered a 'treatment', as the relief is expected to wear off within an hour or two, at a maximum. Active research continues into the accuracy and risks of this provocative test. Current research on TOS and the use of Blocks is underway at Johns Hopkins Hospital, Baltimore, MD.
The goal of self stretching is to relieve compression in the thoracic cavity, reduce blood vessel and nerve impingement, and realign the bones, muscles, ligaments, and tendons causing the problem.
Nerve Gliding
This syndrome causes a compression of a large cluster of nerves, resulting in the impairment of nerves throughout the arm. By performing nerve gliding exercises one can stretch and mobilize the nerve fibers. Chronic and intermittent nerve compression has been studied in animal models, and has a well-described pathophysiology, as described by Susan Mackinnon, MD, currently at Washington University in St. Louis. Nerve gliding exercises have been studied by several authorities, including David Butler in Australia.
Posture
TOS is rapidly aggravated by poor posture. Active breathing exercises and ergonomic desk setup can both help maintain active posture. Often the muscles in the back become weak due to prolonged (years) hunching.
Ice/Heat
Ice can be used to decrease inflammation of sore or injured muscles. Heat can also aid in relieving sore muscles by improving circulation to them. While the whole arm generally feels painful, some relief can be seen when ice/heat is applied to the thoracic region (collar bone, armpit, or shoulder blades).
Acupuncture is also an effective method of treatment for TOS. Patients may feel significantly less pain within 3-4 acupuncture treatment sessions.
Injected into a joint or muscle, cortisone can help relief and lower inflammation.
Botox injections
Botox, short for Botulinum Toxin A, binds nerve endings and prevents the release of neurotransmitters that activate muscles. A small amount of Botox injected into the tight or spastic muscles (usually one or all three scalenes) found in TOS sufferers often provides months of relief while the muscle is temporarily paralyzed. This noncosmetic treatment is unfortunately not covered by most medical plans and costs upwards of $400. The relief of symptoms from a Botox injection generally lasts 3–4 months, at which point the Botox toxin is degraded by the affected muscles. Serious side effects have been reported, and are similarly long-lasting, so improved understanding of the mechanism of a 'scalene block' is vital to determining the benefit and risk of using Botox. Additionally, many patients report no relief of symptoms from Botox or scalene injections, which may indicate that the pain does not stem from the scalene muscle, and may not be TOS. Botox can be a effective treatment for neurogenic TOS. It may allow for the patient to apply physical therapy pain free and thereby be able to properly stretch and open up the compressed area.
Surgical Approaches
Surgical approaches have also been used. In cases where the first rib is compressing a vein, artery, or the nerve bundle, the first rib and scalene muscles and compressive fibrous tissue can be removed. The procedure is called a first rib resection and scalenectomy and involves going through the underarm area or anterior scalene neck area and removing the first rib, scalene muscles, and any compressive fibrous tissue to open the area to allow blood flow and reduce nerve compression. In some cases there is also a rudimentary rib, or a cervical rib that can be causing compression, which can be removed using the same technique.
Physical therapy is used both before the operation and after to further the patient's success in recovery. Complications include pneumothorax, infection, loss of feeling, pain, and as in all surgeries, a very small risk of death and a risk of permanent lifelong injury.
players Matt Harrison
, Hank Blalock
, John Rheinecker
, Jeremy Bonderman
, Alex Cobb
, Kenny Rogers, Jarrod Saltalamacchia
, and Noah Lowry
have recently been diagnosed with Thoracic outlet syndrome. Kenny Rogers was diagnosed several years earlier with TOS in the other upper extremity. Coincidentally, five of these eight players have played for the Texas Rangers
. All-Star pitcher J. R. Richard suffered a career-ending stroke from an undiagnosed case of TOS. Pitcher David Cone
had a variant case of TOS, with an arterial aneurysm of the upper aspect of his pitching arm. Craig Carton
of WFAN had Thoracic outlet syndrome and underwent successful microsurgery to cure it.
Overhead athletes, such as swimmers, track and field runners such as (Eric Baumgartner) and volleyball players, are known to be predisposed to the development of TOS.
Musician Isaac Hanson
suffered a potentially life threatening pulmonary embolism
as a complication of thoracic outlet syndrome.
Brachial plexus
The brachial plexus is a network of nerve fibers, running from the spine, formed by the ventral rami of the lower four cervical and first thoracic nerve roots...
(nerves that pass into the arm
Arm
In human anatomy, the arm is the part of the upper limb between the shoulder and the elbow joints. In other animals, the term arm can also be used for analogous structures, such as one of the paired forelimbs of a four-legged animal or the arms of cephalopods...
s from the neck
Neck
The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...
), and/or the subclavian artery
Subclavian artery
In human anatomy, the subclavian arteries are two major arteries of the upper thorax , below the clavicle . They receive blood from the top of the aorta...
or rarely the vein
Subclavian vein
The subclavian veins are two large veins, one on either side of the body. Their diameter is approximately that of the smallest finger.-Path:Each subclavian vein is a continuation of the axillary vein and runs from the outer border of the first rib to the medial border of anterior scalene muscle...
which does not normally pass through the scalene hiatus (blood vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
s as they pass between the chest and upper extremity). Rarely a Pancoast tumour in the apex of the lung may be the cause.
The compression may be positional (caused by movement of the clavicle
Clavicle
In human anatomy, the clavicle or collar bone is a long bone of short length that serves as a strut between the scapula and the sternum. It is the only long bone in body that lies horizontally...
(collarbone) and shoulder girdle on arm movement) or static (caused by abnormalities or enlargement or spasm of the various muscles surrounding the arteries
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
, vein
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...
s, and brachial plexus), a first rib fixation and a cervical rib.
Common orthopaedic tests used are the Adson's test, the CostoClavicular manoeuvre and the Hands-Up test of East. Careful examination and X-ray are required to differentially diagnose between positional and static aetiology, first rib fixations, scalene muscle spasm and a cervical rib or fibrous band.
By structures affected & symptomatology
There are three main types of TOS, named according to the cause of the symptoms; however these 3 classifications have been coming into disfavor because TOS can involve all 3 types of compression to various degrees: The compression occurs in three anatomical structures, arteries, veins and nerves; isolated, or more commonly two or three of the structures are compressed. Compression can be of different magnitude in each of these structures. Therefore symptoms can be protean. http://www.tos-syndrome.com/old1/newpage12.htm- neurogenic TOS, disorders produced by compression of the components of the brachial plexus nerves. The neurogenic form of TOS accounts for 95% of all cases of TOS.
- arterial TOS, caused by compression of the subclavian artery.
- venous TOS, caused by compression of the subclavian vein.
By event
There are many causes of TOS. The most frequent cause is trauma, either sudden, as in a clavicle fracture caused by a car accident, or repetitive trauma, as in a legal secretary who works with his hands, wrists, and arms at a fast paced desk station with non-ergonomic posture for many years. TOS is also found in certain occupations involving lots of lifting of the arms and repetitive use of the wrists and arms.One cause of arterial compression is trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, and a recent case involving fracture of the clavicle has been reported
The two groups of people most likely to develop TOS are those suffering from neck injuries from traffic collisions and those who use computers in non-ergonomic postures
Human position
Human positions refers to the different positions that the human body can take.There are several synonyms that refer to the human position, often used interchangeably, but having specific flavors....
for extended periods of time. It is a frequent repetitive stress injury caused by certain types of work environments. Other groups which may develop TOS, are athletes who frequently raise their arms above the head (such as swimmers, volleyball
Volleyball
Volleyball is a team sport in which two teams of six players are separated by a net. Each team tries to score points by grounding a ball on the other team's court under organized rules.The complete rules are extensive...
players, shuffle
Shuffle
Shuffling is a procedure used to randomize a deck of playing cards to provide an element of chance in card games. Shuffling is often followed by a cut, to help ensure that the shuffler has not manipulated the outcome.-Shuffling techniques:...
players, baseball pitchers, and weightlifters), rock climbers, electricians who work long hours with their hands above their heads and also some musician
Musician
A musician is an artist who plays a musical instrument. It may or may not be the person's profession. Musicians can be classified by their roles in performing music and writing music.Also....* A person who makes music a profession....
s.
By structure causing constriction
It is also possible to classify TOS by the location of the obstruction:- Scalenus anticus syndrome (compression on brachial plexusBrachial plexusThe brachial plexus is a network of nerve fibers, running from the spine, formed by the ventral rami of the lower four cervical and first thoracic nerve roots...
and/or subclavian arterySubclavian arteryIn human anatomy, the subclavian arteries are two major arteries of the upper thorax , below the clavicle . They receive blood from the top of the aorta...
caused by muscle growth) – diagnosed by using Adson's signAdson's signAdson's sign is seen when the head is turned to the side during deep inspiration, when there is loss of the radial pulse in the arm.It is sometimes used as a sign of thoracic outlet syndrome .It is named for Alfred Washington Adson....
with patient's head turned outward. - Cervical ribCervical ribA cervical rib is a supernumerary rib which arises from the seventh cervical vertebra. It is a congenital abnormality located above the normal first rib. A cervical rib is present in only about 1 in 500 of people; in even rarer cases, an individual may have two cervical ribs...
syndrome (compression on brachial plexusBrachial plexusThe brachial plexus is a network of nerve fibers, running from the spine, formed by the ventral rami of the lower four cervical and first thoracic nerve roots...
and/or subclavian arterySubclavian arteryIn human anatomy, the subclavian arteries are two major arteries of the upper thorax , below the clavicle . They receive blood from the top of the aorta...
caused by bone growth) – diagnosed by using Adson's signAdson's signAdson's sign is seen when the head is turned to the side during deep inspiration, when there is loss of the radial pulse in the arm.It is sometimes used as a sign of thoracic outlet syndrome .It is named for Alfred Washington Adson....
with patient's head turned inward. - CostoclavicularCostoclavicular ligamentThe costoclavicular ligament , is the anatomical name of a ligament that is short, flat, strong, and rhomboid in form....
syndrome (narrowing between the clavicleClavicleIn human anatomy, the clavicle or collar bone is a long bone of short length that serves as a strut between the scapula and the sternum. It is the only long bone in body that lies horizontally...
and the first ribRibIn vertebrate anatomy, ribs are the long curved bones which form the rib cage. In most vertebrates, ribs surround the chest, enabling the lungs to expand and thus facilitate breathing by expanding the chest cavity. They serve to protect the lungs, heart, and other internal organs of the thorax...
) – diagnosed with the costoclavicular maneuver.
Some people are born with an extra, incomplete and very small rib above the first rib, which protrudes out into the superior thoracic outlet space and this rib causes fibrous changes around the brachial plexus nerves and causes the symptoms of Thoracic Outlet Syndrome. This is called a Cervical Rib, and is attached to the C-7. The symptoms of Thoracic Outlet Syndrome can first appear in the early teen years as a child is becoming more athletic. Surgical removal of this rib is almost always recommended.
Symptoms and consequences
TOS affects mainly the upper limbs, especially the arms and hands. Pain in the arms and hands is almost always present. Pain can be sharp, burning, or aching. Pain can involve only part of the hand, as in the 4th and 5th finger only, or all of the hand. It can involve the inner aspect of the forearm and upper arm. Pain can also be in the side of the neck, the pectoral area below the clavicle, the axillary area, and the upper back, as in the trapezius and rhomboid area. Decoloration of the hands is also a possible symptom, and one hand colder than the other hand is also common. Weakness of the hand and arm muscles is also common. Tingling can also be present.TOS is often the underlying cause of stubborn upper limb conditions like frozen shoulder and carpal tunnel syndrome that defy standard treatment protocols.
Cerebrovascular arterial insufficiency when they affect the subclavian artery. It also can affect the vertebral artery, case in which it could produce transient blindness, and embolic cerebral infarction.
A painful, swollen and blue arm, usually occurring after strenuous physical activity, could be a sign of a venous compression or subclavian vein thrombosis, called Paget-Schroetter Syndrome.
Diagnosis
Adson's signAdson's sign
Adson's sign is seen when the head is turned to the side during deep inspiration, when there is loss of the radial pulse in the arm.It is sometimes used as a sign of thoracic outlet syndrome .It is named for Alfred Washington Adson....
and the costoclavicular maneuver are notoriously inaccurate, and may be a small part of a comprehensive history and physical examination of a patient with TOS. There is currently no single clinical sign that makes the diagnosis of TOS with certainty.
Additional maneuvers that may be abnormal are the stick em up "hand raise" for up to 3–5 minutes (holding both hands at right angles bent at the elbows over head, with or without hand opening and closing fingers, the affected hand will often quickly become paler than the unaffected because of compromised blood supply) and the "compression test" (pressure between the clavicle and medial humeral head causes radiation of pain / numbness into the affected arm).
Other Radiographic & helpful Diagnostic Tools to help determine Thoracic Outlet Syndrome
Doppler Arteriography, with probes at the fingertips and arms, tests the force of the arterial flow through the radial arteries and then having the patient perform various arm maneuvers (which causes compression of the subclavian artery at the thoracic outlet) is very helpful to evaluate thoracic outlet syndrome, by eliciting symptoms of pain, numbness and graphs with diminished arterial blood flow to the fingertips with various arm maneuvers provides strong evidence of impingement of the subclavian artery at the thoracic outlet.MRI/MRA Special high resolution MRI/MRA of the Brachial Plexus
Some physicians advocate the injection of a short-acting anesthetic such as xylocaine or marcaine into the anterior scalene, subclavius, or pectoralis minor muscles as a provocative test to assist in the diagnosis of thoracic outlet syndrome. This is referred to as a 'scalene block' with the use of Lidocaine or similar drug. However, this is not considered a 'treatment', as the relief is expected to wear off within an hour or two, at a maximum. Active research continues into the accuracy and risks of this provocative test. Current research on TOS and the use of Blocks is underway at Johns Hopkins Hospital, Baltimore, MD.
Treatment
Most patients respond to conservative measures. Only a minority of patients with signs and symptoms of TOS ultimately proceed to surgery.Noninvasive
StretchingStretching
Stretching is a form of physical exercise in which a specific skeletal muscle is deliberately elongated, often by abduction from the torso, in order to improve the muscle's felt elasticity and reaffirm comfortable muscle tone. The result is a feeling of increased muscle control, flexibility and...
The goal of self stretching is to relieve compression in the thoracic cavity, reduce blood vessel and nerve impingement, and realign the bones, muscles, ligaments, and tendons causing the problem.
- Moving shoulders forward (hunching) then back to neutral, followed by extending them back (arching) then back to neutral, followed by lifting shoulders then back to neutral.
- Tilting and extending neck opposite to the side of injury while keeping the injured arm down or wrapped around the back.
Nerve Gliding
This syndrome causes a compression of a large cluster of nerves, resulting in the impairment of nerves throughout the arm. By performing nerve gliding exercises one can stretch and mobilize the nerve fibers. Chronic and intermittent nerve compression has been studied in animal models, and has a well-described pathophysiology, as described by Susan Mackinnon, MD, currently at Washington University in St. Louis. Nerve gliding exercises have been studied by several authorities, including David Butler in Australia.
- Extend your injured arm with fingers directly outwards to the side. Tilt your head to the otherside, and/or turn your head to the other side. A gentle pulling feeling is generally felt throughout the injured side. Initially, only do this and repeat. Once this exercise has been mastered and no extreme pain is felt, begin stretching your fingers back. Repeat with different variations, tilting your hand up, backwards, or downwards.
Posture
Human position
Human positions refers to the different positions that the human body can take.There are several synonyms that refer to the human position, often used interchangeably, but having specific flavors....
TOS is rapidly aggravated by poor posture. Active breathing exercises and ergonomic desk setup can both help maintain active posture. Often the muscles in the back become weak due to prolonged (years) hunching.
Ice/Heat
Ice can be used to decrease inflammation of sore or injured muscles. Heat can also aid in relieving sore muscles by improving circulation to them. While the whole arm generally feels painful, some relief can be seen when ice/heat is applied to the thoracic region (collar bone, armpit, or shoulder blades).
Acupuncture is also an effective method of treatment for TOS. Patients may feel significantly less pain within 3-4 acupuncture treatment sessions.
Invasive
CortisoneCortisone
Cortisone is a steroid hormone. It is one of the main hormones released by the adrenal gland in response to stress. In chemical structure, it is a corticosteroid closely related to corticosterone. It is used to treat a variety of ailments and can be administered intravenously, orally,...
Injected into a joint or muscle, cortisone can help relief and lower inflammation.
Botox injections
Botox, short for Botulinum Toxin A, binds nerve endings and prevents the release of neurotransmitters that activate muscles. A small amount of Botox injected into the tight or spastic muscles (usually one or all three scalenes) found in TOS sufferers often provides months of relief while the muscle is temporarily paralyzed. This noncosmetic treatment is unfortunately not covered by most medical plans and costs upwards of $400. The relief of symptoms from a Botox injection generally lasts 3–4 months, at which point the Botox toxin is degraded by the affected muscles. Serious side effects have been reported, and are similarly long-lasting, so improved understanding of the mechanism of a 'scalene block' is vital to determining the benefit and risk of using Botox. Additionally, many patients report no relief of symptoms from Botox or scalene injections, which may indicate that the pain does not stem from the scalene muscle, and may not be TOS. Botox can be a effective treatment for neurogenic TOS. It may allow for the patient to apply physical therapy pain free and thereby be able to properly stretch and open up the compressed area.
Surgical Approaches
Surgical approaches have also been used. In cases where the first rib is compressing a vein, artery, or the nerve bundle, the first rib and scalene muscles and compressive fibrous tissue can be removed. The procedure is called a first rib resection and scalenectomy and involves going through the underarm area or anterior scalene neck area and removing the first rib, scalene muscles, and any compressive fibrous tissue to open the area to allow blood flow and reduce nerve compression. In some cases there is also a rudimentary rib, or a cervical rib that can be causing compression, which can be removed using the same technique.
Physical therapy is used both before the operation and after to further the patient's success in recovery. Complications include pneumothorax, infection, loss of feeling, pain, and as in all surgeries, a very small risk of death and a risk of permanent lifelong injury.
Notable patients
Major League BaseballMajor League Baseball
Major League Baseball is the highest level of professional baseball in the United States and Canada, consisting of teams that play in the National League and the American League...
players Matt Harrison
Matt Harrison
Matthew Reid Harrison is a Major League Baseball left-handed starting pitcher for the Texas Rangers.-Baseball career:Harrison attended South Granville High School in Creedmoor, North Carolina...
, Hank Blalock
Hank Blalock
Hank Joe Blalock is a Major League Baseball third baseman who is currently a free agent.-High school:Blalock attended Rancho Bernardo High School in San Diego, California...
, John Rheinecker
John Rheinecker
John Philip Rheinecker is a former Major League Baseball pitcher.-High school years:Rheinecker attended Gibault Catholic High School in Waterloo, Illinois, and was a student and a letterman in baseball. He grew up in Hecker, Illinois and first starred at the Hecker Dome...
, Jeremy Bonderman
Jeremy Bonderman
Jeremy Allen Bonderman is a Major League Baseball starting pitcher who currently is a free agent. Bonderman is six feet and two inches tall and weighs 220 pounds. He bats and throws right-handed...
, Alex Cobb
Alex Cobb
Alexander Miller "Alex" Cobb is a Major League Baseball pitcher for the Tampa Bay Rays.-Professional career:Cobb was called up to the majors for the first time on May 1, 2011 and made his major league debut that day. He was optioned back to the minors after the game. On May 31, Cobb was recalled...
, Kenny Rogers, Jarrod Saltalamacchia
Jarrod Saltalamacchia
Jarrod Scott Saltalamacchia , nicknamed "Salty" is an American professional baseball catcher with the Boston Red Sox of Major League Baseball.His last name is the longest in Major League Baseball history...
, and Noah Lowry
Noah Lowry
Noah Ryan Lowry is a free agent left-handed starting pitcher formerly of the San Francisco Giants of Major League Baseball.-College and the MLB Draft:...
have recently been diagnosed with Thoracic outlet syndrome. Kenny Rogers was diagnosed several years earlier with TOS in the other upper extremity. Coincidentally, five of these eight players have played for the Texas Rangers
Texas Rangers (baseball)
The Texas Rangers are a professional baseball team in the Dallas-Fort Worth Metroplex, based in Arlington, Texas. The Rangers are a member of the Western Division of Major League Baseball's American League, and are the reigning A.L. Western Division and A.L. Champions. Since , the Rangers have...
. All-Star pitcher J. R. Richard suffered a career-ending stroke from an undiagnosed case of TOS. Pitcher David Cone
David Cone
David Brian Cone is a former Major League Baseball pitcher. During a 17-year baseball career, he pitched from 1986-2003 for six different teams. Cone pitched the sixteenth perfect game in baseball history. He also set the MLB record for most years between 20-win seasons. He was a member of five...
had a variant case of TOS, with an arterial aneurysm of the upper aspect of his pitching arm. Craig Carton
Craig Carton
Craig Harris Carton is an American radio personality who currently co-hosts the Boomer and Carton in the Morning radio program.-Biography:...
of WFAN had Thoracic outlet syndrome and underwent successful microsurgery to cure it.
Overhead athletes, such as swimmers, track and field runners such as (Eric Baumgartner) and volleyball players, are known to be predisposed to the development of TOS.
Musician Isaac Hanson
Isaac Hanson
Isaac Hanson is an American musician best known as a member of the pop rock trio Hanson, which includes his two younger brothers Taylor and Zac...
suffered a potentially life threatening pulmonary embolism
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
as a complication of thoracic outlet syndrome.
See also
- Paget-Schroetter diseasePaget-Schroetter diseasePaget-Schroetter disease, also known as Paget-von Schrötter disease or upper extremity deep vein thrombosis is a medical condition in which blood clots form in the deep veins of the arms. These deep vein thromboses typically occur in the axillary vein or subclavian vein.-Signs and symptoms:The...
- May-Thurner syndromeMay-Thurner syndromeIn medicine, May-Thurner syndrome is a rare condition in which blood clots, called deep venous thrombosis , occur in the iliofemoral vein due to compression of the common venous outflow tract of the left lower extremity. The specific problem is compression of the left common iliac vein by the...
- Similar compression in the left common iliac vein.
External links
- Thoracic Outlet Syndrome PART I: A clinical review, Journal of American Chiropractic Association
- Physical Therapy Corner - Thoracic Outlet Syndrome
- Society for Vascular Surgery (U.S.)
- Thoracic Outlet Syndrome Patient Information