Thoracic Outlet Syndrome (TOS) - Clinical Scenario

A 40-year-old woman presents with increasing bilateral arm heaviness and paraesthesia that worsens when elevating her arms. Initially, these symptoms appeared only after prolonged overhead activities but have begun to manifest almost immediately upon arm elevation. Additionally, she notes the transient loss of radial pulse in the right arm when elevated. She has been using crutches due to a past sciatic nerve surgery, which she believes may be exacerbating her symptoms.


Objectives:
1. Describe the anatomy of the thoracic outlet.
2. Take a detailed history of a patient with TOS.
3. Consider the differential diagnosis of TOS.
4. Request appropriate investigations for a patient with likely TOS.
5. Create a management plan for a patient with TOS.

Primary Contributor: Dr Suzanne Thomson, Educational Fellow.
Reviewer: Dr Kurt Lee Chircop, Educational Fellow.