Journal of Autoimmune Disorders

Introduction

In the last decade, the use of hand-held devices (HHDs) such as cellphones, gaming controllers, tablets, portable media players, and personal digital assistants has exploded. Even musculoskeletal professionals struggle to understand the thoracic outlet architecture and how the bundle moves through the channel. As a result, clinicians trained in other fields typically have a poor knowledge of the nature of thoracic outlet syndrome and how to explain it. Thoracic outlet syndrome is a syndrome rather than a disease, according to the Mayo Clinic, Cleveland Clinic, and hence the National Institute of Neurological Disorders and Stroke, as well as top ten ranked hospitals for neurology and neurosurgery. The three models of human locomotion will be discussed.

Thoracic outlet syndrome

(TOS) is a collection of symptoms caused by neurovascular compression at the thoracic outlet, usually resulting in some combination of pain.The precise constellation of signs and symptoms depends on the precise structures being compressed, but common pain symptoms can result from damage to the vena subclavia, subclavian artery, or various parts of the brachial plexus.although any subtype of TOS can be difficult to diagnose, NTOS is especially difficult due to the branching anatomy of the plexus brachialis, which results in different constellations of pain, sensory disturbance, and weakness depending on which parts are compressed.This is perhaps often exemplified by the fact of many classification systems.

External neurological examination

A external neurological examination should compare the affected limb's tone, power, reflexes, and sensation to the contralateral limb.The distribution of symptoms such as weakness, numbness, and paraesthesias may also vary, the sensory disturbance of the arm, as well as weakness and atrophy of the deltoid, biceps, and brachialis muscles All these points are in the involvement of the upper brachial plexus (C5-C7), Lower plexus (C8-T1) involvement is suspected when there is weakness in the small muscles of the hand as well as weakness of the wrist and finger flexion.

The ulnar forearm and hand may be more affected by sensory loss. In reality, upper and lower plexus involvement may be present in 85–90% of NTOS cases. at this stage, one of the most important aspects of the examination is attempting to Carpal tunnel syndrome and cubital tunnel syndrome are examples of peripheral compressive neuropathies to rule out.

Carpal tunnel syndrome

This will cause sensory disturbance confined to the distribution of the median nerve, and tinel's and phalen's tests may also be positive, with sensitivities of 67 percent and 85 percent, respectively, and specificities of 68 percent and 89 percent, Cubital tunnel syndrome may also present with sensory disturbances similar to those seen in lower plexus compression, however, in cubital tunnel syndrome, elbow flexion frequently aggravates these symptoms, however, it should be noted that TOS can co- exist with these peripheral compressive neuropathies, so the presence of those tests does not rule out a TOS diagnosis.

Peripheral vascular examination

A pulsatile mass within the supraclavicular and infraclavicular fossae, a sign of aneurysmal change, should be palpated during a peripheral vascular examination, auscultation can also be used to detect a bruit., a vital sign difference between arms of 20 mmHg was also found on rare occasions in ATOS, While the above tests may not yield any results in many cases of vascular TOS, provocative manoeuvres are frequently used to bring these differences to light.

Acknowledgements

The author is thankful to the people who supported and participated in this research. The de dermatology hospital who approved this study as well as the research and development team for their invaluable support during the study.

Conflict of Interest

There is no conflict disclosed in this article.