What anatomy of the thoracic outlet relevant to thoracic outlet syndrome?

Updated: Jan 10, 2019
  • Author: Daryl A Rosenbaum, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

The neurovascular bundle courses through 3 spaces, or triangles, as it exits the neck to reach the axilla and proximal arm. All 3 spaces can be the source of compression of the various components of the neurovascular bundle, including the brachial plexus and the subclavian vessels. [13] These spaces are small at rest and become even smaller with certain arm maneuvers, such as abduction and external rotation. [14, 15] This can aid in the diagnosis of thoracic outlet syndrome and forms the basis for provocative testing, which is discussed later (see Clinical, Physical).

The first space is the interscalene triangle. It is bordered by the anterior scalene muscle, the middle scalene muscle, and the upper border of the first rib. This space contains the trunks of the brachial plexus and subclavian artery. The interscalene triangle is the most common site for neural compression, vascular compression, or both. [11]

The second space is the costoclavicular triangle, which is bordered by the clavicle, first rib, and scapula and contains the subclavian artery and vein and the brachial nerves.

The third and final space is beneath the coracoid process just deep to the pectoralis minor tendon; it is referred to as the subcoracoid space.


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