Evaluation and Management of Neurogenic Thoracic Outlet Syndrome with an Overview of Surgical Approaches: A Comprehensive Review

Abstract

Neurogenic thoracic outlet syndrome (NTOS) represents a disorder believed to involve compression of one or more neurovascular elements as they exit the thoracic outlet. This comprehensive literature review will focus on the occurrence, classification, etiology, clinical presentation, diagnostic measures, and both nonoperative and operative therapies for NTOS. NTOS represents the most common subtype of thoracic outlet syndrome and can significantly impair quality of life. Botulinum toxin injection into the anterior scalene muscle, or even the middle scalene or pectoralis minor muscles, can reduce the symptoms of this syndrome. The best available evidence for botulinum toxin therapy to the cervicothoracic muscles supports the value of this treatment for reducing pain in the affected extremity, and for an approximate duration of 2 months or more. Surgical approaches and newer minimally invasive surgical approaches offer high rates of improvement in select centers.

Novel Use of Ali Shahab Score as a Diagnostic Tool and Decision of Surgical Management in Scalenus Syndrome: A Case Series

“…In scalenus syndrome, the subclavian artery is compressed by anterior scalenus muscle, which leads to narrowing of the vessel lumen. The sympathetic nervous system also innervates the subclavian artery [1], [7], [11]. We hypothesized that the stenotic subclavian artery and compression by the scalenus muscle, the pulse of the subclavian artery, lead to the sympathetic impulse to ganglion stellate.…”

“…Under the general anesthesia, the patient was placed in a supine position with the head positioned in neck extension, tilting to the contralateral side of the operation. Previous supraclavicular scalenectomy techniques had been described before and used in this study [7], [10], [13]. A transverse incision was done above the medial third of the clavicle and deepened layer by layer.…”

“…However, we suggested that these two clinical entities are different. TOS is a collection of symptoms caused by the compression not only in the scalene triangle but also the costoclavicular space and retropectoralis minor space [7], [8]. Moreover, TOS is caused by static pathologies; meanwhile, scalenus syndrome is caused by dynamic pathology, which is the hardening of the anterior scalene muscle [1], [6], [8], [9].…”

“…The diagnosis of scalenus syndrome is mainly based on clinical findings due to the subclavian artery and brachial plexus compression. Work-up examinations such have limitations to diagnose scalenus syndrome [7], [8], [12]. We proposed Ali Shahab score as a mean to overcome the challenges in diagnosing scalenus syndrome as the score was generated based on clinical findings.…”

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

“…The symptoms of TOS are complex and may manifest as pain in the neck region, numbness along the arms, hand numbness, impaired gross motor strength of the arm muscles, loss of sensation in the hands, cold arms and hands, poor circulation in the hands, pain in the hands, chest pain, throbbing sensations, palpitations, shoulder pain, headaches, dizziness, tinnitus, and loss of consciousness [4,5]. As their presence compromises the affected individual's quality of life (QoL) [6,7], particularly sleep quality [8,9], further assessments are required, given that sleep is a physiologically unconscious state, and its main function is to revitalize the body and conserve energy [10].…”