Thoracic outlet syndrome: A functional dysfunction of the upper thoracic aperture?

Area of Science:

• Orthopedics
• Radiology
• Physical Therapy

Background:

• Thoracic outlet syndrome (TOS) is a condition characterized by symptoms arising from compression of neurovascular structures in the thoracic outlet.
• The precise cause of TOS symptoms can be multifactorial, necessitating detailed investigation of anatomical structures.

Purpose of the Study:

• To investigate upper thoracic aperture malfunction, defined as first rib upward displacement at the costotransverse joint, as a cause of TOS symptoms.
• To evaluate the effectiveness of conservative treatment in TOS patients with identified upper thoracic aperture abnormalities.

Main Methods:

• A cohort of 15 consecutive TOS patients undergoing conservative treatment were assessed.
• Three-dimensional CT scans of the upper thoracic aperture were used to identify first rib displacement.
• Patients received a standardized rehabilitation program, with outcomes assessed after 1 year.

Main Results:

• First rib upward displacement at the costotransverse joint was observed in 12 out of 15 patients on the symptomatic side.
• The majority of patients (11/15) were engaged in sedentary work.
• Conservative therapy was effective in most patients, with only 3 non-responders.

Conclusions:

• Malfunction of the upper thoracic aperture, particularly first rib displacement, is strongly associated with TOS symptoms.
• Sedentary work appears to be a significant contributing factor in patients with this specific TOS etiology.
• Individualized conservative therapy programs tailored to functional findings are recommended for optimal patient outcomes.