![]() We call this presentation pseudo-Thoracic outlet syndrome. It is worth mentioning that many referrals for TOS seen in physiotherapy clinics in modern day, may not have direct compression of the structures causing the patients symptoms. Physiotherapists must differentiate TOS from other issues such as cervical radiculopathy, painful and inflexible trapezius or shoulder muscles, rotator cuff irritations or tears, shoulder bursitis etc. TOS can be easily confused with other neurological issues in the arms. TOS can also occur from repetitive functional, sporting or occupational activities such as overhead throwing, excessive pushing activities, and can be worsened with poor postural awareness around the shoulder, neck and upper back. In rare cases, a birth defect in which people can have an extra rib (Cervical Rib) can cause the compression of both the nerves and blood vessels. Often athletes are effected by PSS, specifically, those engaging in the repetitive over-the-head motion of their arms, including baseball or softball pitchers, swimmers, rowers, or weightlifters.Ĭauses of TOS include traumatic injuries such as whiplash, sports impact injuries or falls. ![]() PSS is more commonly seen in younger patients -in their 20s and 30s -with a male to female ratio of 2:1. Venous TOS is also possible following repetitive motion and can be sometimes referred to as Paget–Schroetter disease (PSS). Compression of the subclavian artery and vein are seen less then that of the nerves, however, tend to occur more in congenital TOS. In fact, these cases make up 90% of patients presenting with TOS. According to a 2019 study, the most common type of TOS is neurogenic, or nervy in nature – in which the Brachial Plexus is the main structure being compressed.
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