Recurrent Neurogenic Thoracic Outlet Syndrome (TOS): A Systematic Review of the Literature

Abstract

Introduction Thoracic outlet syndrome (TOS) is a set of symptoms that arise when neurovascular bundles are compressed in the course of passage through three spaces: the costoclavicular junction, the scalene triangle, and the pectoralis minor space. This study aims to review the literature regarding the proper management of recurrent TOS. Methods We conducted a systematic literature search using various databases up to December 20, 2022. The study included those articles in which the symptoms were regarded as recurrent if TOS-related symptoms like pain and/or discomfort recurred following an initial resolution of symptoms. Multiple data were gathered from the included studies, including the publication year, first author, country, sex, age, type of primary intervention, duration of physiotherapy, type of reoperation, compressing structures, and the outcome. Results The study included 14 articles. Two of the articles were case reports, 10 were case series, and the remaining were cohort studies. A total of 686 patients were included, of whom 506 (73.7%) were female. The ages ranged from 17 to 79 years, with varying means across the age groups. Nine out of 14 (64%) studies reported the first rib remnant as one of the causative factors in the recurrence of TOS. Excellent or good results were reported in 474 (69%) patients. Conclusion Recurrent TOS is a relatively common finding after primary treatment for neurogenic TOS. Management is similar to primary TOS, including conservative management and surgical intervention. The latter should not be delayed if conservative treatment fails.