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WHAT IS TOS?

TOS Definition

CARLOS A. SELMONOSKY, M.D.

The throracic outlet syndrome is a group of symptoms arising not only from the upper extremity, but also from the chest, neck, shoulders and head.

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 Diagnostic Triad during physical examination:

  1. Weakness of the 5th finger

  2. Elevation of the hand maneuver

  3. Supraclavicular tenderness

The following is a numerical listing for the drawing to the right.

Please either print this listing or a copy of the drawing.


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.