Imaging findings of thoracic outlet syndrome include 10: MR imaging is useful in patients with neurogenic thoracic outlet syndrome particularly in evaluating the brachial plexus and surrounding structures. Imaging is performed with the patient’s arms both in the raised (abducted) and neutral (adducted) positions for comparison. Imaging with ultrasound, contrast-enhanced CT, MRI or conventional angiography is useful for detecting vascular thoracic outlet syndrome (e.g. Scalenus anticus syndrome: abnormal insertion of scalenus anterior onto 1 st rib (commonest cause)īony abnormality of 1 st rib or clavicle (congenital anomaly, malunited fracture, callus, Paget disease, tumor)Ĭhest radiography is typically performed to exclude an underlying bone abnormality. ![]() The subclavian artery and branches of the brachial plexus pass through the borders of this triangle while the subclavian vein passes anterior to it. The scalene triangle is defined by the first rib and the anterior and middle scalene muscles and is the most medial compartment. Retropectoralis minor space: between pectoralis minor and coracoid process Scalene triangle: between scalenus anterior and scalenus medius musclesĬostoclavicular space: between the clavicle and 1 st rib There are three common sites of compression: The findings are exacerbated by certain arm positions and maneuvers, particularly with the arms raised (abducted) above the head 9. Subclavian artery compression causes ischemia with coolness, pallor, claudication, paresthesia and decreased upper limb pulsesĭamage to the subclavian artery at the level of the first ribĬombined neurovascular symptoms and signs may be present. Some can present with symptoms of intermittent venous compression in the absence of thrombosis ( McCleery syndrome) Subclavian vein compression causes upper limb swelling and pain and may result in venous thrombosis ( Paget-Schroetter syndrome) ![]() ![]() Clinical presentation will depend on the structure compressed and the degree of compression:īrachial plexus compression results in pain, paresthesia and/or numbness of the upper limb
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