Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions

Abstract

The diagnosis of thoracic outlet syndrome (TOS) has long been a controversial and challenging one. Despite common presentations with pain in the neck and upper extremity, there are a host of presenting patterns that can vary within and between the subdivisions of neurogenic, venous, and arterial TOS. Furthermore, there is a plethora of differential diagnoses, from peripheral compressive neuropathies, to intrinsic shoulder pathologies, to pathologies at the cervical spine. Depending on the subdivision of TOS suspected, diagnostic investigations are currently of varying importance, necessitating high dependence on good history taking and clinical examination. Investigations may add weight to a diagnosis suspected on clinical grounds and suggest an optimal management strategy, but in this changing field new developments may alter the role that diagnostic investigations play. In this article, we set out to summarise the diagnostic approach in cases of suspected TOS, including the importance of history taking, clinical examination, and the role of investigations at present, and highlight the developments in this field with respect to all subtypes. In the future, we hope that novel diagnostics may be able to stratify patients according to the exact compressive mechanism and thereby suggest more specific treatments and interventions.

Sonographic Pearls for Imaging the Brachial Plexus and Its Pathologies

“…Thoracic outlet syndrome (TOS) pertains to compression of the neurovascular structures in the cervico-axillary region dynamically [24]. It can be provoked by the posture e.g., side bending/rotation of the neck, excessive abduction of the arm and hyper-retraction of the scapulae.…”

“…It can be provoked by the posture e.g., side bending/rotation of the neck, excessive abduction of the arm and hyper-retraction of the scapulae. The causes of the syndrome can be neurogenic or vascular (subclavian artery or vein) compression [25] whereby several physical tests (e.g., Adson, costoclavicular, Roos and Wright) have been used in the diagnosis, mainly to examine vascular compression [24]. The three regions where the BP can be compressed are the interscalene triangle, costoclavicular space and the retro-pectoralis minor region.…”

Thoracic Outlet Syndrome: Biomechanical and Exercise Considerations

“…There is generally no agreement on the etiology of TOS, which can make prescribing treatment for the condition difficult. Proper physical examination of the patient can help differentiate between the various forms of TOS, and other conditions that elicit similar symptoms of TOS (i.e., carpal tunnel syndrome or pectoralis minor syndrome) [ 17 , 19 , 20 ]. Approximately 90% of all TOS cases are diagnosed as nTOS [ 4 , 11 , 12 ].…”

Ultrasound for Neurogenic Thoracic Outlet Obstruction Remains Theoretical

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We enjoyed reading Povleson et al's review entitled "Diagnostic thoracic outlet syndrome: current approaches and future directions" [1]. The authors performed a thorough review of current and emerging investigations available for the diagnosis of thoracic outlet syndrome (TOS).

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