This review reframes pectoralis minor syndrome as the primary cause of neurogenic thoracic outlet syndrome. It walks through the anatomy, dynamic pathophysiology, a staged diagnostic algorithm, and nonoperative and surgical management. The focus shifts compression from the scalene triangle to the retropectoralis minor space.
When a young overhead athlete presents with vague anterior shoulder pain, intermittent paresthesias, and a protracted scapula, think pectoralis minor syndrome before scalene-based TOS. The mental model: repetitive protraction shortens the pectoralis minor, which collapses the retropectoralis minor space and compresses the plexus cords during elevation.
Do not rely on Adson, Wright, or Roos maneuvers. They are unreliable. Anchor your diagnosis on tenderness and Tinel's over the coracoid insertion, then confirm with an ultrasound-guided anesthetic injection. A greater than 50% response to injection both confirms the diagnosis and predicts a good surgical outcome.
Start with 6 months of pectoralis minor stretching and scapular retraining, which resolves symptoms in most patients. Reserve open or arthroscopic release for failures, and add suprascapular nerve release or brachial plexus neurolysis only when the workup localizes those sites.
This review reframes pectoralis minor syndrome as the primary cause of neurogenic thoracic outlet syndrome. It walks through the anatomy, dynamic pathophysiology, a staged diagnostic algorithm, and nonoperative and surgical management. The focus shifts compression from the scalene triangle to the retropectoralis minor space.
When a young overhead athlete presents with vague anterior shoulder pain, intermittent paresthesias, and a protracted scapula, think pectoralis minor syndrome before scalene-based TOS. The mental model: repetitive protraction shortens the pectoralis minor, which collapses the retropectoralis minor space and compresses the plexus cords during elevation.
Do not rely on Adson, Wright, or Roos maneuvers. They are unreliable. Anchor your diagnosis on tenderness and Tinel's over the coracoid insertion, then confirm with an ultrasound-guided anesthetic injection. A greater than 50% response to injection both confirms the diagnosis and predicts a good surgical outcome.
Start with 6 months of pectoralis minor stretching and scapular retraining, which resolves symptoms in most patients. Reserve open or arthroscopic release for failures, and add suprascapular nerve release or brachial plexus neurolysis only when the workup localizes those sites.