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Thoracic Outlet Obstruction (Examination Inspection (Arm: ↓ venous…
Thoracic Outlet Obstruction
Examination
Inspection
Arm: ↓ venous outflow
Oedema: pitting
Cyanosis
Pallor
Hand: ↓ arterial inflow
Raynaud’s
Patchy gangrene
Fingertip necrosis
Hand and Arm: neurological complications
Complete claw hand
T1 sensory loss
Radicular pain
Palpation
Palpate for cervical rib above the supraclavicular fossa
Disappearance of radial pulse on abduction and external rotation of arm
Viva
Differential of Thoracic Outlet Obstruction
Arterial: Raynaud’s
Venous: axillary vein thrombosis or trauma
Neurological: cervical spondylosis, Pancoast’s tumour
Ix
X-Ray: cervical rib
Duplex in abduction
Arteriograms of subclavian artery may show kinking
Nerve conduction studies
Aetiology
Congenital: cervical rib
Acquired: clavicle #, pathological enlargement