1. Unilateral Arm Swelling
Tim Kubal

2. Venogram

3. Provocative Venogram

4. Thoracic Outlet Syndrome
Compression of neurovascular structures as they pass through the thoracic outlet.
NTOS, ATOS, VTOS (Paget-Schroetter Syndrome)
Whiplash, Repetitive activity, rib anomaly, prior clavicular fx, fibrosis.

5. Anatomy

6. NTOS
Most common with the majority of these cases being related to trauma and virtually impossible to diagnose objectively
Paresthesias, pain
Tx conservatively in majority of cases unless demonstrable anatomical abnormality then consider surgery

7. VTOS
Majority of cases related to strenuous or repetitive overhead activity.
Acute or subacute swelling, heaviness, pain, venous distention with visible collaterals.
Acute: Thrombolytics, stenting/venoplasty, surgical decompression, anticoagulation.
Subacute: Conservative vs. Surgery

8. ATOS Least common Subclavian Artery Compression
Typically secondary to demonstrable rib abnormality
Pain, Paresthesias, Cyanosis, Embolism, Negative Pulses, Slow capillary refill

9. How do i work this up? Provocative testing
Dopplers (Acutely r/o thrombosis)
C-Spine films, shoulder films
CT chest

10. Management
VTOS: Usually requires urgent thrombolysis, anticoag, surgical decompressions
ATOS: surgical decompression and restoration of arterial blood flow
NTOS: PT, surgical decompression.

11. Surgery
Rib, muscle resection
Less stuff
More space

12. What else could it be? Brachial plexus injury Carpal Tunnel CRPS
Malignancy
C-Spine or shoulder MSK
Nothing

13. TOS
JR Richard (CVA)
David Cone (Arterial aneurysm)
Hanson