Chris Mallac explores the different causes of thoracic outlet syndrome and the typical signs and symptoms that usually plague an athlete in this confusing, poorly defined, and difficult-to-diagnose problem.
First described over 200 years ago and named as Thoracic Outlet Syndrome (TOS) in 1956, TOS is a pathological disease process that involves a compression of the neurovascular bundle of the brachial plexus and possibly the associated veins and arteries(1,2). This compression results in a constellation of symptoms that may mimic other more common cervical and upper limb pathologies.
The anatomical thoracic outlet ‘container’ comprises numerous structures that may create neurovascular compression. The term TOS describes a symptom complex defined by the anatomical location of the pathophysiology and is not a true diagnosis.
Overall, it is more common in women (4:1) and estimated to affect up to 8% of the population(3,4). However, the incidence in athletes is unclear. In athletes, it is most common in baseball pitchers(5), golfers, weight lifters, volleyballers, swimmers, rowers, water polo players, gymnasts, tennis players, and those in throwing sports like cricket(6,7,8).
There are two types of TOS– neurological TOS (NTOS) and vascular TOS (see figure 1) (9-16):
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