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The ribs make up the floor of the thoracic outlet with the main nerves
that go to the upper extremity (brachial plexus) sitting on top. When the
ribs are shoved up, as in the diagram below, the result is irritation of
the brachial plexus and numbness down that arm. In many patients, direct
trauma to the ribs is not required. A one sided, cervical facet injury
(indicated in red on the right) causes the neck to tilt away from this
painful joint. The brain then rights the head to keep the eyes level, thus
forcing one side of the ribs up (black arrow) and causing TOS on the
opposite side (numbness indicated by yellow arrow). |
