Acta Neurochir Suppl 100:137–139Ĭzihal M, Banafsche R, Hoffmann U, Koeppel T (2015) Vascular compression syndromes.

J Hand Ther 19(4):410–419 (quiz 420)īahm J (2007) Critical review of pathophysiologic mechanisms in thoracic outlet syndrome (TOS). Eura Medicophys 43(1):55–70Įstilaei SK, Byl NN (2006) An evidence-based review of magnetic resonance angiography for diagnosing arterial thoracic outlet syndrome. Vanti C, Natalini L, Romeo A, Tosarelli D, Pillastrini P (2007) Conservative treatment of thoracic outlet syndrome. Understanding the status of the art and the underlying reasons of doubts and weaknesses could help clinical practice and set the stage for future research. Only articles focused on neurogenic TOS were considered. In the attempt to shed more light on this condition, we performed a systematic review of the literature and report evidence and opinions around this controversial subject. While some experts believe that TOS is underrated, overlooked and very frequent, others even doubt its existence as a nosological entity. Despite the large amount of articles, there is still controversy regarding its classification, clinical picture, diagnostic objective findings, diagnostic modalities, therapeutical strategies and outcomes. From literature analysis on nerve entrapments, we realized that TOS is the second most commonly published entrapment syndrome in the literature (after carpal tunnel syndrome) and that it is even more reported than ulnar neuropathy at elbow, which, instead, is very frequent. In addition to the usual surgical risks, post-operative reflex sympathetic dystrophy is also encountered 1.Despite its low prevalence and incidence, considerable debate exists in the literature on thoracic outlet syndrome (TOS). Success rate varies and improvement, if attained, is not always permanent, with 15-30% recurrence of symptoms 1,2. Resection of the first rib, cervical rib and scalenectomy are all performed using a variety of approaches. Options depend on the site of postulated compression. Surgical decompression is controversial 1. Injection of anesthetic agents or botulinum toxin into the anterior scalene muscle can also be of benefit 2. occupational health and safety), orthoses, physiotherapy etc.

Preventative changes and rehabilitation remain the mainstay treatment for most cases of neurogenic thoracic outlet syndrome, focussing on reducing risk factors (e.g. a cervical rib) in a patient with painful neurogenic thoracic outlet syndrome does not mean that it is the cause 1. It is essential to remember, however, that identifying an anatomical abnormality (e.g. CT and MRIīoth CT and MRI are able to assess regional anatomy. Specific anatomical features to be sought include:įirst rib callus, exostosis or osseous lesion Plain radiographĬhest radiography is typically performed to exclude an underlying bony abnormality. Radiographic featuresĪs the vast majority of cases of neurogenic thoracic outlet syndrome have no anatomical abnormalities, imaging is primarily used to exclude unexpected and rare mechanical causes of compression as well as to exclude other potential causes of pain (e.g. Some authors have termed this 'true' neurogenic thoracic outlet syndrome 1. In a very small proportion of cases, muscular atrophy may be present, typically of the thenar eminence, and later, other intrinsic muscles of the hand 1. In the vast majority of cases, no objective findings can be identified and these are referred to as the painful neurological form of thoracic outlet syndrome. The distribution of pain will depend on which part of the brachial plexus is affected upper thoracic outlet syndrome (C5-C7) is more proximal, whereas lower thoracic outlet syndrome (C8 - T1) involves the hand 2.

Patients present with pain around the shoulder girdle, extending into the arm and even up into the neck and/or face 1,2. Most often it presents in adulthood (30 - 40 years of age is typical) and it is rare in childhood 2. Prevalence of neurogenic thoracic outlet syndrome has been estimated as high as 8% of the population and most frequently seen in women (female to male ratio 4:1) 2.

Neurological thoracic outlet syndrome