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Presentation on
Thoracic Outlet Syndrome
by
Dr James Stoxen DC
Presented at the
12th Annual World Congress on Anti-aging Medicine
Mandalay Bay Hotel and Casino, Las Vegas Nevada
December 4, 2004
A presentation of the most effective diagnosis, treatment and prevention of
Thoracic Outlet Syndrome (TOS)
Table of Contents
Chapter I
Dr Stoxen's Introduction Read it here...
What is Thoracic Outlet Syndrome?
Our Experience
Chapter II
Anatomy of Thoracic Outlet Syndrome Read it here...
Three Areas of Compression
The Intrascalene Triangle
The Costoclavicular Space
The Intrapectoral Space
Arteries, Veins and Nerves pass through the Thoracic Outlet
Other anatomy
Chapter III
Thoracic Outlet Syndrome Controversy Read it here...
Thoracic Outlet Syndrome is controversial in the medical community.
Underdiagnosed or Overdiagnosed
No Gold Standard Test Exists
Most common Treatment is Surgery
Surgery is unnecessary with the right approach
Why Current Conservative Therapy is Unsuccessful
Chapter IV
History or Patient Presentation Read it here...
Symptoms of Thoracic Outlet Syndrome
What is a careful history
Possible Causes of Thoracic Outlet Syndrome
Static Postural Stress and Traumatic Injury – Two
Primary causes of TOS
Static Postural Stress .
Static Postural Stress – Mechanism of Injury
Example 1: Reading or Watching TV in Bed
Example 2: Computer use
Traumatic Injury - Traumatic Epidemiology
Chapter V
Physical Examination Findings Read it here...
Cervical Range of Motion
Spasms in the Scalenes
Swelling in the hands
Manual Muscle Testing and TOS
Rotator Cuff Muscle Testing
Orthopedic Tests
(+) Hyperabduction Maneuver - Roos Test
(+) Adsons Test
(+) Costoclavicular Test
Shoulder Orthopedic Tests
Rotator Cuff Syndrome and TOS
Chiropractic Examination
Superior Rib Subluxation or First Rib Motion Palpation
Chapter VI
Diagnostic Tests for TOS Read it here...
When to order diagnostic tests
1. X-ray Examination
Retrolestisis is a common finding in TOS
Costochondral arthritic changes
2. Electrophysiologic Test
3. Multi-directional CT and 3-dimensional reconstructions
4. Venography
5. Doppler ultrasonagraphy
6. Magnetic Resonance Angiography
7. CT Angiography
Chapter VII
Differential Diagnosis Read it here...
1. Klippleflie Syndrome
Klippleflie Syndrome predisposes patients to TOS
2. Clavicular Fracture Malunion
3. Pancost Tumor
4. Carpal Tunnel Syndrome
5. Nerve Impingement (herniated disc)
6. Double Crunch - Combined Carpal Tunnel and Nerve Impingement
7. Raynaud’s Phenomenon
8. Spinal Cord Neoplasms
9. Brachial Neuritis
10. Cervical Spondylosis
11. Myofacial Pain Syndrome
12. Subclavian steel syndrome and angina pectoris
13. Cervical Ribs
Chapter VII
Treatment of Thoracic Outlet Syndrome Read it here...
Address the cause
Medication - Why medication alone will not work
Manipulation - Why superior first rib correction is a necessity
Physiotherapy - Why therapy is difficult alone
Muscle Therapy - Why scalene muscle spasms must be reduced
Stretching - Why some stretching makes this condition worse
Manipulation - Why improper manipulation makes it worse
Cracking the neck - Why this makes TOS worse
Therapeutic exercises or rehabilitation
Conservative vs Surgery
First Rib Subluxation in the literature
Surgical Approach - When do you need surgery?
Chapter VIII -
Frequently asked questions about TOS
Why first rib manipulation isnt in the literature?
Why some doctors think TOS doesnt exist
Why is manipulation works and cracking the neck worsen TOS? Why do patients with TOS have upper back pain?
Why do I have shortness of breath at times?
Why do so many patients with TOS have headaches too?
Why is it difficult to correct the headaches and TOS at the same time?
What is the tingling or numbness in the fingertips?
Artery or nerve?
Why are symptoms more common the morning with TOS
Why do the hands swell in the morning with TOS?
Why do patients with TOS have swelling of the neck area?
How long will this take to get better?
Chapter IX
Case Histories of Patients with TOS
Table of Contents Return...
Chapter I Dr Stoxen's Introduction Read it here...
Chapter II Anatomy of Thoracic Outlet Syndrome Read it here...
Chapter III Thoracic Outlet Syndrome Controversy Read it here...
Chapter IV History or Patient Presentation Read it here...
Chapter V Physical Examination Findings Read it here...
Chapter VI Diagnostic Tests for TOS Read it here...
Chapter VII Treatment of Thoracic Outlet Syndrome Read it here...
Chapter IX Case Histories of Patients with TOS
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