Diagnostic and Therapeutic Management of the Thoracic Outlet Syndrome. Review of the Literature and Report of an Italian Experience

Abstract

The Thoracic Outlet Syndrome is a clinical potentially disabling condition characterized by a group of upper extremity signs and symptoms due to the compression of the neurovascular bundle passing through the thoracic outlet region. Because of the non-specific nature of signs and symptoms, to the lack of a consensus for the objective diagnosis, and to the wide range of etiologies, the actual figure is still a matter of debate among experts. We aimed to summarize the current evidence about the pathophysiology, the diagnosis and the treatment of the thoracic outlet syndrome, and to report a retrospective analysis on 324 patients followed for 5 years at the Padua University Hospital and at the Naples Fatebenefratelli Hospital in Italy, to verify the effectiveness of a specific rehabilitation program for the syndrome and to evaluate if physical therapy could relieve symptoms in these patients.

Arthroscopic Pectoralis Minor Release After Reverse Shoulder Arthroplasty

“…The treatment of nTOS remains controversial. Nonoperative therapy has been shown to produce positive results in 60 to 70% of patients, leaving 30% to 40% of patients who require surgical intervention 18 . In those patients who fail a 3- to 6-month scapular focused therapy protocol, the surgical options include open or arthroscopic approaches.…”

Sleep Problems and Disabilities of the Arm, Shoulder, and Hand in Persons with Thoracic Outlet Syndrome—A Cross-Sectional Study

“…The therapeutic approach in the treatment of TOS should be multidisciplinary and comprehensive [16]. Conservative treatment strategies should ideally combine physical (diathermy, laser, TENS, and ultrasound) and medicinal approaches (starting with non-steroidal anti-inflammatory drugs and/or opioids, and progressing to miorelaxants, anticonvulsants, anticoagulants, pregbalin, and eventually botulinum toxin injections), with emphasis on daily application of kinesitherapy (postural and ergonomic education) [51][52][53].…”

Langzeitergebnisse nach Operation des neurogenen Thoracic-Outlet-Syndroms bei Jugendlichen

“…Typische Symptome für das nTOS sind bewegungsabhängige Schmerzen, insbesondere bei Überkopfarbeiten oder Tragen schwerer Lasten, die mit sensiblen Störungen oder Kribbelparästhesien in den Versorgungsgebieten vom Truncus inferior, seltener Truncus superior und medius, sowie Paresen an den entsprechenden Muskeln einhergehen. Bei ausgeprägter Kompression kann sich eine Atrophie der intrinsischen Handmuskulatur, des Thenars und Hypothenars entwickeln [7][8][9].…”