Wright test: a provocation test used to reproduce paresthesia and changes in the radial pulse by performing the following maneuvers.Negative: no change in pulse or sensation.Positive: reduced or absent pulse or paresthesia.Passive abduction of 90° and lateral rotation and extension of the arm. The patient sits in a relaxed position while the examiner palpates the radial pulse.Adson test : a provocation test that is used to reproduce symptoms of TOS.Swelling and venous distention in the arm may be a sign of venous thrombosis of the arm. Ischemia can lead to ulcerations and gangrene of the affected arm.Compression of the subclavian artery ( 20 mm Hg in the affected arm compared to the contralateral arm.Risk of thrombosis of the arm ( Paget-Schroetter disease).Compression of the subclavian vein ( up to 3% of cases).Gilliatt-Sumner hand : atrophy of intrinsic hand muscles, including the thenar, hypothenar, lumbrical, and interossei muscles.Sensory loss or paresthesia (follows the distribution of the ulnar nerve ).Compression of parts of the brachial plexus (95% of cases).EtiologyĬlinical features of TOS depend on the anatomic structure affected by compression and are more pronounced during and after o verhead activity. Surgical resection of the causal structures might become necessary in the case of progressive neurologic dysfunction or acute vascular insufficiency. Mild symptoms should be treated with pain medication and physical therapy. Imaging techniques such as duplex sonography, X-ray, MRI, or electrodiagnostic testing are used to detect the cause of TOS. Venous TOS results in pain, cyanosis, and swelling of the arm. Arterial TOS involves compression of the subclavian artery and presents with pain, pallor, coldness, and pulselessness in the affected arm, especially during overhead activities. Neurogenic TOS is the most common type and involves the compression of the brachial plexus, leading to neck pain and numbness and tingling in the fingers. Causes include trauma, tumors, or the presence of a cervical rib. Thoracic outlet syndrome (TOS) is an umbrella term for conditions involving the compression of neurovascular structures (e.g., the brachial plexus or the subclavian artery or vein) as they pass from the lower neck to the armpit.
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