Thoracic Outlet Canada
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Symptomatic or Disputed TOS The fourth variant, known as symptomatic or disputed TOS, may be quite common, but it is also quite controversial because its determinants are subjective. It is estimated that 95% of TOS cases present with symptoms relating to compression of the nerves in the brachial plexus. Of those 95%, most (94%+) are due to symptomatic TOS. True neurogenic TOS is very rare. The body schema diagram shown below was completed by a 26 year-old patient who had symptomatic TOS. Quite typical is the post-occipital pain with or without headache, the referral of pain to the upper scapular region posteriorly and to the anterior pectoral area. This patient experienced numbness and tingling in the ulnar two fingers on the affected side (lower root TOS). Her anterior chest wall pain was unusual. All of these symptoms were aggravated by arm elevation, carrying heavy objects, driving for extended distances, and by performing repetitive activities such as vacuuming. Because of her chest pain she underwent cardiac catheterization, found to be normal. These symptoms were first experienced within an hour of a motor vehicle accident in which her stationary car was struck from the rear. Her pain and hand tingling/numbness was relieved by first rib resection three years after the accident. No objective signs were found on physical examination or on EMG study. Her CT scan showed elongated transverse processes of C7. At surgery she was found to have two congenital fibrous bands, one posterior and the other anterior to the lower elements of the brachial plexus. 
[arterial] | [venous] | [neurogenic] | [symptomatic] |