Defining Diagnostic Criteria for Neurogenic Thoracic Outlet Syndrome: An Expert Consensus

Area of Science:

• Orthopedics
• Neurology
• Vascular Surgery

Background:

• Neurogenic thoracic outlet syndrome (nTOS) presents with varied symptoms, leading to diagnostic challenges.
• Establishing clear diagnostic criteria for nTOS is crucial for accurate patient management.

Purpose of the Study:

• To achieve expert consensus on the most relevant clinical criteria for distinguishing nTOS.
• To facilitate the development of a diagnostic algorithm for nTOS.

Main Methods:

• A Delphi method was employed with 20 upper extremity experts.
• Experts ranked 54 clinical items for distinguishing nTOS using a 0-10 scale.
• Cronbach's alpha was calculated to assess inter-rater reliability.

Main Results:

• A high degree of consensus (Cronbach's α = .936) was achieved among experts.
• Five clinically significant criteria for nTOS were identified:
• These include response to specific injections, symptom exacerbation with provocative maneuvers (supraclavicular and infraclavicular), pain reproduction with specific movements/tests, and history of repetitive arm stress activities.

Conclusions:

• The study established 5 consensus-based clinical criteria for diagnosing nTOS.
• These criteria provide a foundation for a future nTOS diagnostic algorithm.
• The proposed criteria can improve diagnostic accuracy and streamline treatment for nTOS.