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Dynamic anatomical variations of tunnels have been
postulated as possible etiologies for various tunnel syndromes. This figure
shows dynamic compression of the brachial plexus in the thoracic outlet.
1: Pectoralis minor muscle; 2: coracoid process; 3: median
nerve; 4: subclavian artery; 5: brachial plexus; 6: medial scalene muscle; 7:
anterior scalene muscle; 8: internal jugular vein; 9: common carotid artery; 10:
costoclavicular ligament; 11: subclavious muscle; 12: subclavian vein; 13:
Clavicle; 14: First Ribs.
CARLOS A. SELMONOSKY, M.D.
The symptoms are produced by a positional, intermittent compression of the brachial plexus and/or subclavian artery vein and the vertebral artery.
The diagnosis is made easier by the physician's awareness and by use of the Selmonosky Triad during physical examination. (Elevation of the hands, supraclavicular tenderness, weakening of the 4th and 5th fingers.)
RICHARD J. SANDERS, M.D.
The simple definition of thoracic outlet syndrome is neurovascular symptoms in the upper extremities due to pressure on the nerves and vessels in the thoracic outlet area. The specific structures compressed are usually the nerves of the branchial plexus and occasionally the subclavian artery or subclavian vein.
E.W. POLLAK, M.D.
Symptoms and signs of thoracic outlet syndrome are due to the compression or irritation of the neurovascular bundle at the various levels of the cervico-auxillary and thoraco-brachial passages.
Depending on the exact site of injury and the injury component of the neurovascular bundle, three distinct syndromes or a combination thereof may be encountered. One, neurological syndrome - Two, arterial syndrome - Three, venous syndrome.
A careful history and physical examination leads to a positive diagnosis in most instances.