The clot formation is due to changes in the artery as a result of a congenital extra rib, called a cervical rib or abnormal first rib. Even when a clot forms, most people do not develop symptoms until the clot breaks into small pieces which flow down the arm to block arterial circulation at the elbow or hand. These people are the ones who can develop obstruction and clots in the vein from excessive arm and shoulder activity.Īrterial TOS is caused by clot formation in the artery to the arm (subclavian artery) in the area just behind the collar bone. However, some people are born with a very narrow space through which the vein travels. Most people have adequate room for the main vein to travel from the arm to reach the heart. Pressure against the vein is due to variations in normal anatomy. Venous TOS is often caused by strenuous use of the arm which irritates the main vein to the arm (subclavian vein) lying behind the collar bone (the clavicle). This in turn puts pressure against the nerves to the arm which causes the symptoms. The injury results in over-stretching neck muscles which heal by forming scar tissue in the muscle. Neurogenic TOS is most often caused by neck trauma, whiplash injuries or repetitive stress injury at work being the most common events that bring on symptoms. The three types of TOS are very different from each other. The appropriate terms, arterial or venous, should be employed and the term vascular discarded. The term refers to TOS due either to compression of an artery or vein (arterial or venous TOS). Vascular TOS is a term sometimes used but there is no such entity as vascular TOS. Arterial TOS-compression of the main artery comprises less than 1% of all TOS patientsĤ. Venous TOS-compression of the main vein comprises 4% of all TOS patientsģ. Neurogenic TOS-nerve compression comprises 95% of all TOS patientsĢ. There are three types of TOS depending on which structure is being compressed:ġ. The cause is pressure in the neck against the nerves and blood vessels that go to the arm. Thoracic outlet syndrome (TOS) is a condition presenting with arm complaints of pain, numbness, tingling and weakness. *This condition is no longer considered rare
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