By event
There are many causes of TOS. The most frequent cause is trauma, either sudden (as in a clavicle fracture caused by a car accident), or repetitive (as in a legal secretary who works with his/her hands, wrists, and arms at a fast-paced desk station with non-ergonomic posture for many years). TOS is also found in certain occupations involving much lifting of the arms and repetitive use of the wrists and arms. One cause of arterial compression is trauma, and a recent case involving fracture of the clavicle has been reported.The two groups of people most likely to develop TOS are those with neck injuries due to traffic accidents and those who use computers in non-ergonomic postures for extended periods of time. TOS is frequently a repetitive stress injury (RSI) caused by certain types of work environments. By structure causing constriction
It is also possible to classify TOS by the location of the obstruction:
Anterior scalene syndrome (compression on brachial plexus and/or subclavian artery caused by muscle growth). Cervical rib syndrome (compression on brachial plexus and/or subclavian artery caused by bone growth). Costoclavicular syndrome (narrowing between the clavicle and the first rib) – diagnosed with the costoclavicular maneuver.Some people are born with an extra incomplete and very small rib above their first rib, which protrudes out into the superior thoracic outlet space. This rudimentary rib causes fibrous changes around the brachial plexus nerves, inducing compression and causing the symptoms and signs of TOS.
In some cases there may be a rudimentary rib or a cervical rib that can be causing the compression, which can be removed using the same technique.Physical therapy is often used before and after the operation to improve recovery time and outcomes. Potential complications include pneumothorax, infection, loss of sensation, motor problems, subclavian vessel damage, and, as in all surgeries, a very small risk of permanent serious injury or death. Notable cases
SportsSeveral Major League Baseball players, especially pitchers, have been diagnosed with thoracic outlet syndrome, including Stephen Strasburg, Chris Archer, Matt Harvey, Chris Carpenter, Jaime Garcia, Shaun Marcum, Matt Harrison, Clayton Richard, Nate Karns, and Noah Lowry. Starting pitcher Chris Young, who previously struggled with shoulder problems, underwent surgery for TOS in 2013 and felt "completely different" post-recovery. Young exceeded expectations on his return to the major leagues at age 35, becoming a valuable member of the 2014 Seattle Mariners starting rotation. In July 1980, Houston Astros starting pitcher J.R. Richard collapsed while playing a game of catch, and was found to have experienced a stroke due to severe blockage of his right carotid artery. Given the fact that shortly beforehand, he had been found to have near-total obstruction of the arteries supplying his right arm, he was eventually diagnosed with extensive arterial thoracic outlet syndrome. Although he attempted a comeback, his professional baseball career was effectively ended.NHL defenseman Adam McQuaid was diagnosed with TOS in September 2012, and as a result was nominated for the Bill Masterton Memorial Trophy.