New Diagnostic and Treatment Modalities for Neurogenic Thoracic Outlet Syndrome

Abstract

Neurogenic thoracic outlet syndrome is a widely recognized, yet controversial, syndrome. The lack of specific objective diagnostic modalities makes diagnosis difficult. This is compounded by a lack of agreed upon definitive criteria to confirm diagnosis. Recent efforts have been made to more clearly define a set of diagnostic criteria that will bring consistency to the diagnosis of neurogenic thoracic syndrome. Additionally, advancements have been made in the quality and techniques of various imaging modalities that may aid in providing more accurate diagnoses. Surgical decompression remains the mainstay of operative treatment; and minimally invasive techniques are currently in development to further minimize the risks of this procedure. Medical management continues to be refined to provide non-operative treatment modalities for certain patients, as well. The aim of the present work is to review these updates in the diagnosis and treatment of neurogenic thoracic outlet syndrome.

Thoracic Outlet Syndrome Induced by Huge Lipoma: A Case Report

“…However, surgical treatment is needed when there is extrinsic compression of the neurovascular bundle at the thoracic outlet area 6). In order to predict the surgical effect, blocking the scalene muscle or pectoralis minor can be attempted to observe for improvement in the clinical symptoms 67). In our case, because of neuropathy due to lipoma, surgical treatment was performed.…”

“…This site includes three trunks and cords of the brachial plexus and an axillary vascular bundle. This space is relatively wide and less structurally abnormal than other sites, and incidence of TOS is low 47). Most cases of TOS due to a mass have been reported in this space 235).…”

Thoracic Outlet Syndrome: A Comprehensive Review of Pathophysiology, Diagnosis, and Treatment

“…Neurogenic TOS is generally more difficult to diagnose as nerve and tissue inflammation lack consistent radiographic evidence. However, as imaging studies evolve, newer modalities with higher quality allow for improved diagnostic objectivity [56]. MRI can evaluate the anatomy of the thoracic outlet, the soft tissue structures causing compression, and allow direct visualization of brachial plexus compression [40].…”

Concurrent Validity of Digital Vascular Auscultation for the Assessment of Blood Flow Obliteration on the Radial Artery in Healthy Subjects

“…The performance of provocative manoeuvres is indicated for the clinical diagnosis of neurogenic TOS [ 6 , 7 ]. Adson’s test, Eden’s test, Wright’s test, and the Roos or Elevated Arm Stress Test (EAST) are commonly used for this purpose.…”