Thoracic outlet syndrome: a review.

Area of Science:

• Vascular Surgery
• Neurology
• Orthopedics

Background:

• Thoracic outlet syndrome (TOS) is a rare condition caused by neurovascular compression.
• It presents with diverse symptoms including arm pain, swelling, fatigue, paresthesias, weakness, and hand discoloration.
• TOS is classified as neurogenic, arterial, or venous based on the compressed structure.

Purpose of the Study:

• To review diagnostic tests and treatment options for TOS.
• To guide clinicians in recognizing and treating vascular TOS.
• To focus on objectively verifiable forms of neurogenic TOS.

Main Methods:

• Review of diagnostic approaches including history, physical examination maneuvers, and imaging.
• Discussion of non-surgical treatments: anti-inflammatory medication, weight loss, physical therapy, and botulinum toxin injections.
• Overview of common surgical treatments: brachial plexus decompression, neurolysis, and scalenotomy with or without first rib resection.

Main Results:

• Diagnosis requires evidence of a physical anomaly, not just symptoms.
• Congenital abnormalities like cervical ribs can cause TOS.
• Nonsurgical and surgical treatment options are available, with specific postoperative rehabilitation protocols.

Conclusions:

• Accurate diagnosis of TOS relies on identifying a correctable physical anomaly.
• Effective management involves a combination of diagnostic tools and tailored treatment strategies.
• This review aims to improve the recognition and treatment of TOS, particularly vascular and verifiable neurogenic presentations.