Knowledge of muscle variations in the major compartments of the thoracic outlet: The key in recognition of thoracic outlet syndrome

Georgi P. Georgiev^*

Department of Orthopaedics and Traumatology,University Hospital Queen Giovanna - ISUL, Sofia, Bulgaria.

*Corresponding Author:

Georgi P. Georgiev
Department of Orthopaedics and Traumatology
University Hospital Queen Giovanna
ISUL, Medical University of Sofia ul. Bialo More 8
BG 1527 Sofia, Bulgaria
Telephone +359884 493523
E-mail: georgievgp@yahoo.com

Published Online: 2 June 2017

Citation: Georgiev GP. Knowledge of muscle variations in the major compartments of the thoracic outlet: The key in recognition of thoracic outlet syndrome. Int J Anat Var. 2017;10(2):20.

© This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http:// creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact reprints@pulsus.com

Thoracic outlet syndrome include upper extremity symptoms that occur due to compression of the brachial plexus and subclavian-axillary vessels in the thoracic outlet region, between the neck and the axilla (1-3). Although the etiology of thoracic outlet syndrome is multifactorial, in many patients musculoskeletal abnormalities resulting in a compression of neurovascular structures were detected (1-5). Most patients’ complaint of arm pain, hand numbness, weakness and wasting of the hand muscles and rarely with some circulatory changes. These symptoms tend to worsen by any prolonged activity of the arm (1-3).

Unfortunately, there is no single criterion and no specific physical tests for detection of thoracic outlet syndrome (1,2). The diagnosis is usually based on a combination of clinical, electrophysiological tests and the use of different imaging modalities. This diagnosis also requires different specialists to identify a cause and location and to provide information for eventual surgical repair (1-3).

A good knowledge of the variant structures, possibly compressing the neurovascular structures from the base of the neck to the axilla, is essential for clinicians to identify the cause of thoracic outlet syndrome (6).

The variant structures are divided according to the major compartments of the thoracic outlet

1. The interscalene triangle (variation of the anterior and middle scalene muscles).

2. The costoclavicular space (aberrant fibrous bands).

3. The retropectoralis minor space (deep axillary arch muscle).

References

1. Budhiraja V, Rastogi R, Jain V, et al. Anatomical variations of renal artery and its clinical correlations: a cadaveric study from central India. J Morphol Sci. 2013;30:228-33.
2. Georgiev GP, Jelev L. Bilateral fibrous replacement of subclavius muscle in relation to nerve and artery compression of the upper limb. Int J Anat Var. 2009;2:57-9.
3. Georgiev GP, Surchev L, Jelev L. Variant fibrous structures in costoclavicular interval–possible cause for thoracic outlet syndrome. Compt rend Acad bulg Sci. 2007;60:813-6.
4. Jelev L, Georgiev GP, Ovtscharoff W. Anatomical variations in relation to thoracic outlet syndrome. Scripta Scientif Med. 2011;43:129.
5. Georgiev GP, Jelev L, Surchev L. Axillary arch in Bulgarian population: clinical significance of the arches. Clin Anat. 2007;20:286-91.
6. Jelev L, Georgiev GP, Surchev L. Axillary arch in human: common morphology and variety. Definition of “clinical” axillary arch and its classification. Ann Anat. 2007;189:473-81.

Georgi P. Georgiev^*

Department of Orthopaedics and Traumatology,University Hospital Queen Giovanna - ISUL, Sofia, Bulgaria.

*Corresponding Author:

Georgi P. Georgiev
Department of Orthopaedics and Traumatology
University Hospital Queen Giovanna
ISUL, Medical University of Sofia ul. Bialo More 8
BG 1527 Sofia, Bulgaria
Telephone +359884 493523
E-mail: georgievgp@yahoo.com

Published Online: 2 June 2017

Citation: Georgiev GP. Knowledge of muscle variations in the major compartments of the thoracic outlet: The key in recognition of thoracic outlet syndrome. Int J Anat Var. 2017;10(2):20.

© This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http:// creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact reprints@pulsus.com

Thoracic outlet syndrome include upper extremity symptoms that occur due to compression of the brachial plexus and subclavian-axillary vessels in the thoracic outlet region, between the neck and the axilla (1-3). Although the etiology of thoracic outlet syndrome is multifactorial, in many patients musculoskeletal abnormalities resulting in a compression of neurovascular structures were detected (1-5). Most patients’ complaint of arm pain, hand numbness, weakness and wasting of the hand muscles and rarely with some circulatory changes. These symptoms tend to worsen by any prolonged activity of the arm (1-3).

Unfortunately, there is no single criterion and no specific physical tests for detection of thoracic outlet syndrome (1,2). The diagnosis is usually based on a combination of clinical, electrophysiological tests and the use of different imaging modalities. This diagnosis also requires different specialists to identify a cause and location and to provide information for eventual surgical repair (1-3).

A good knowledge of the variant structures, possibly compressing the neurovascular structures from the base of the neck to the axilla, is essential for clinicians to identify the cause of thoracic outlet syndrome (6).

The variant structures are divided according to the major compartments of the thoracic outlet

1. The interscalene triangle (variation of the anterior and middle scalene muscles).

2. The costoclavicular space (aberrant fibrous bands).

3. The retropectoralis minor space (deep axillary arch muscle).

References

1. Budhiraja V, Rastogi R, Jain V, et al. Anatomical variations of renal artery and its clinical correlations: a cadaveric study from central India. J Morphol Sci. 2013;30:228-33.
2. Georgiev GP, Jelev L. Bilateral fibrous replacement of subclavius muscle in relation to nerve and artery compression of the upper limb. Int J Anat Var. 2009;2:57-9.
3. Georgiev GP, Surchev L, Jelev L. Variant fibrous structures in costoclavicular interval–possible cause for thoracic outlet syndrome. Compt rend Acad bulg Sci. 2007;60:813-6.
4. Jelev L, Georgiev GP, Ovtscharoff W. Anatomical variations in relation to thoracic outlet syndrome. Scripta Scientif Med. 2011;43:129.
5. Georgiev GP, Jelev L, Surchev L. Axillary arch in Bulgarian population: clinical significance of the arches. Clin Anat. 2007;20:286-91.
6. Jelev L, Georgiev GP, Surchev L. Axillary arch in human: common morphology and variety. Definition of “clinical” axillary arch and its classification. Ann Anat. 2007;189:473-81.