by Warren Hammer,MS,DC,DABCO

Thoracic outlet syndrome (TOS) may be more prevalent than you think. It is a condition that requires a diagnosis made more by a history and physical examination than by radiological or electrodiagnostic tests. While cervical ribs and other anatomic variations may be more common in TOS, they are not necessarily a prerequisite for a diagnosis. Of the 282 patients who required surgery for TOS, two-thirds had had normal electromyography testing results.

The problem with establishing a diagnosis is that since both nerves and blood vessels may be compressed, a patient may present with a variety of signs and symptoms. Originally, it was thought that vascular compression created most of the symptoms, but recent studies show that neural compression is responsible for most of the complaints.2

Forty-one percent of the 282 patients had a history of trauma preceding the onset of symptoms, with the shoulder girdle most affected, followed by the neck, arm and hand. Thirty-two percent of the patients blamed their symptoms on the workplace. Poor posture was a significant cause.

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