Symptoms of thoracic outlet syndrome (TOS):

Symptoms include neck, shoulder, and arm pain numbness, tingling (paresthesias), or impaired circulation to the extremities, sometimes causing discoloration.  Often symptoms are reproduced when the arm is positioned above the shoulder or extended.

Types of Thoracic Outlet Syndrome, Diagnosis & Treatment:

Cervical Rib - Compression of the brachial plexus and/or subclavian artery caused by muscle growth or hypertrophy.  The gold standard for diagnosis of a cervical rib is imaging, whether it be a X-ray, CT scan, or MRI.  Treatment is usually surgical in nature by resectioning or removing the cervical rib.

Hyperabduction Syndrome - Compression of the brachial plexus and/or subclavian artery by hypertrophy due to stretching and irritative vasoconstriction.  Probably the most common of the subcategories of TOS and often found in people who sleep with their arms over their heads or tucked under the pillow.  The best way to diagnose hyperabduction syndrome is through the use of nerve conduction velocity (NCV) and plethysmography.  If you look at the videos above both women have hyperabduction syndrome and it is obvious even to an untrained eye that there is diminished blood flow in the third position.  Treatment is conservative in nature, rarely necessitating surgery.

     Scalenus Anticus Syndrome - Compression of the brachial plexus and/or subclavian artery caused by muscle growth or hypertrophy. The best way to diagnose hyperabduction syndrome is through the use of nerve conduction velocity (NCV) and plethysmography.  If there is a vascular component the plethysmography study will often be positive somewhere from the fifth through tenth positions  Treatment is conservative in nature, but in severe cases may require surgery.

      Costoclavicular Syndrome -  Compression of the brachial plexus and/or subclavian artery caused by narrowing between the clavicle and the first rib. The best way to diagnose hyperabduction syndrome is through the use of nerve conduction velocity (NCV) and plethysmography.  If there is a vascular component the plethysmography study will often be positive in the fourth position (milder form of TOS) or the second position (more severe form of TOS).  The difference between the two positions is that in the fourth position the patient inhales deeply and holds it, thereby causing an even greater decrease between the clavicle and first rib.  Treatment is conservative in nature and rarely requires surgery.

*Cautionary Note* - Some websites or physicians may tell you that there are orthopedic tests which can diagnose TOS, such as Adson's Test, Wright's Test, or the Costoclavicular Maneuver.  Don't believe it and here is why (utilizing common sense).  These test require that the physician determine if there is a "diminished pulse or blood flow".  Now most physicians can determine if there is a stoppage of blood flow or dropped beat but it becomes very subjective as to if there is a reduction or diminished blood flow.  Utilizing plethysmography there is no guess work as there is a demonstrable change that even non-medical people can see (if you haven't played the video above do it now and see for yourself).