Ulcerations and non-healing wounds in the fingertips. Signs of digital emboli, such as discolored spots in the fingertips or under the nails. Ischemic arm fatigue may be most evident during maneuvers with the arm elevated overhead. Diminished handgrip strength may be present because of pain that accompanies use of the hand. Cold and pale fingers with diminished sensation. Physical examination of the patient with suspected arterial TOS is directed toward identifying the presence of a subclavian or axillary artery lesion and evaluating the presence and extent of hand ischemia.Įxamination should include inspection of the hand for the presence of: Non-healing wounds or ulcerations in the fingers. Chronic arm fatigue with use or claudication. A sudden onset of hand pain and weakness. Patients with arterial TOS may have one or more of the following symptoms: Patients with arterial TOS will only occasionally have a history of a known cervical rib or previous diagnosis of TOS. In some cases, a significant difference in blood pressure between the arms or a non-tender mass in the lateral lower neck may be present and can be detected upon examination. Unlike other forms of TOS, those with subclavian artery stenosis, occlusions, and aneurysms due to arterial TOS may not exhibit symptoms. (See story of arterial TOS patient treated by Robert Thompson, MD, at The Washington University Center for Thoracic Outlet Syndrome at Barnes-Jewish Hospital.) History and symptoms of arterial TOS Prompt recognition of these various forms of arterial TOS is extremely important, as delays in treatment can lead to severe ischemic complications (restricted blood flow), tissue loss requiring debridement or amputation, and permanent disability. These lesions are caused by repetitive compression and stretching of the axillary artery by the head of the humerus, as it moves forward during extremes of arm elevation and extension, as seen in the overhead pitching motion. 
This form results in either aneurysmal or occlusive lesions, and is a unique condition that appears to occur almost exclusively in baseball pitchers. This is often referred to as formation of a “post-stenotic” arterial aneurysm.Ī second form of arterial TOS affects the distal axillary artery, beyond the level of the first rib near the shoulder. The compression of the subclavian artery caused by the cervical rib leads to turbulent blood flow through the narrowed segment of the artery, and this type of long-standing stress eventually results in degeneration of the arterial wall and formation of an aneurysm in the location of the artery immediately beyond the stenosis, or narrowing. Unique form of arterial TOS occurs with compression of the axillary artery, almost always in overhead throwing athletes.Usually includes narrowing of the subclavian artery and formation of an aneurysm just beyond the narrowed area.Typically caused by subclavian artery compression in association with a cervical rib or first rib anomaly.Arterial TOS is rare and the least frequently encountered thoracic outlet compression disorder.Important features of arterial TOS include the following: Notice of Privacy Practice for Patients (HIPAA).What Your Can Expect from Your Visit – Staying in St.What You Can Expect From Your Visit – Overview.Neurogenic Thoracic Outlet Syndrome (TOS).Arterial Thoracic Outlet Syndrome (TOS).Types of Thoracic Outlet Syndrome (TOS) Types of Thoracic Outlet Syndrome (TOS).Anatomy of the Thoracic Outlet Anatomy of the Thoracic Outlet.
General Features of Thoracic Outlet Syndrome (TOS).
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