文档介绍：Thoracic Outlet Syndrome “TOS”
Sami Asfar
.,Ch.,B., .(UK), FRCSEd, FACS
Professor and Chairman,
Departments of Surgery, Faculty of Medicine, Kuwait University
and Mubarak Al-Kabeer Hospital
Liver & Vascular Surgery
Tafreeq by: Fajer Al-Tammar
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Thoracic outlet:
The space through which the subclavian artery, vein and brachial plexus pass to the upper limb
Symptoms develop when these structures pressed at the outlet
Boundaries:
First rib, clavicle and Scalene muscles
Clavicle
1st Rib
Scalenus Anterior Muscle
{This outlet is very narrow so}
Notice:the vertebral column, in front of scaleneus ant. Is the subclavian vein &behind it is the subclaivein artery&brachial plexus
Patient’s arm is elevated
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{This is a cut-section of the chest. Notice the thoracic outlet- 1st rib, clavicle, brachial plexus, subclavian art &vein.}
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Notice the imp. Anatomical structures in the outlet: Boundaries include the 1st rib, clavicle, and Anterior scalene muscle with the phrenic nerve pasted on it. Under the clavicle is subclaivius muscle, & u can see the apex of the lung, the subclavian vein and artery, and brachial plexus.
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Brachial Plexus
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Brachial Plexus Cont’d
{Anatomy revision:
brachial plexus roots are from C5-T1. These 5 roots form 3 trunks that then divide into 3 anterior divisions and 3 posterior divisions. These divisions then unite into 3 cords which finally end in 5 terminal branches.
* Compression in the thoracic outlet occurs on trunks. If pression is caused by a cervical rib which usually arises from the transverse process of C7, this cervical rib will cause an elevation of the inferior trunk hence leading to symptoms related to the ulnar nerve in the territory of C8&T1. So patient will feel numbness in the little finger and medial side of arm.}
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Causes of TOS
Cervical rib
Elongated C7 transverse process
Fibromuscular bands between C7 and 1st rib
Congenital anomalies of the scalene muscles {sometimes the scalene muscle is very bulky t