Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of vascular thoracic outlet syndrome (vTOS), including unilateral upper extremity edema, cyanosis, and exertional fatigue. Reports heaviness, coolness, and paresthesia exacerbated by overhead activities. Denies trauma, recent surgery, or history of hypercoagulability.
Clinical Examination Findings
Physical exam reveals diminished or absent radial pulses with provocative maneuvers (Adsonโs, Wrightโs, or Roos test). Inspection shows venous distention or arterial insufficiency signs in the affected limb. Auscultation may reveal supraclavicular bruits. Neurological exam is intact, focusing on vascular compromise.
Treatment Protocol
Initial management includes physical therapy focusing on postural correction and scapular stabilization. If vascular compromise is significant, surgical consultation for first rib resection or scalenectomy is indicated. Anticoagulation therapy may be initiated if secondary thrombosis is confirmed.