The thoracic outlet syndrome: Controversies, overdiagnosis, overtreatment, and recommendations for management

Abstract

This review is an objective critique of the thoracic outlet syndrome, with emphasis on the need to separate true neurogenic and vascular syndromes from nonspecific ones. Major controversies in the diagnosis and management of thoracic outlet syndromes are discussed, with an analysis of major pitfalls encountered in the diagnosis and treatment of patients with nonspecific syndromes. Recommendations to improve diagnostic methods in patients with chronic neurovascular abnormalities in the upper extremities are outlined.

Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis

“…5 This controversy extends to almost every aspect of the pathology including the definition, the incidence, the pathoanatomical contributions, diagnosis and treatment. 6,7 The controversy surrounding the definition exists because the term TOS only outlines the location of the problem without actually defining what comprises the problem. In response, investigators have categorized TOS as vascular versus neurogenic, where vascular TOS can be subcategorized as either arterial or venous and neurogenic TOS can subcategorized as either true or disputed.…”

“…Furthermore, the term TOS fails to identify the compressing insult or mechanism, thus prompting individuals to propose an alternative nomenclature that identifies the anatomical factors involved. 6 The disagreement regarding the definition of TOS makes the overall incidence of the condition difficult to track. Complicating matters, the recognized prevalence of the diagnosis varies between disciplines.…”

“…9 As a result, disparities in the definition have produced different opinions regarding diagnostic standards for TOS. 6,7,9,10 Furthermore, given the controversy surrounding the definition and diagnosis of TOS, conflict exists regarding the optimal treatment approach for this condition. [10][11][12] The purpose of this paper is to provide the reader with clarity through: (1) a review of the relevant pathoanatomy; (2) a discussion regarding pathology and differential diagnosis; and (3) a presentation of the examination and special test measures, along with suggested diagnostic paradigms.…”

Síndrome do desfiladeiro torácico tipo neurogênico verdadeiro: relato de dois casos

“…Mais raramente, hipertrofia do músculo escaleno anticus 5 , anormalidades claviculares e lesões adquiridas como trauma com fratura de clavícula e primeira costela, pseudoartrose clavicular e lesão por esmagamento da região torácica superior podem causar SDT 11 . No caso das costelas cervicais e processos transversos de C7 alongados, acredita-se que a banda fibrosa congênita que une a extremidade da anormalidade óssea à primeira costela, cause compressão ou estiramento do tronco inferior ou raízes C8/T1 do plexo braquial.…”

Electrophysiological assessment in neurogenic thoracic outlet syndrome

“…Kronik basıya neden olan faktörler daha çok servikal kot, C7 transvers çıkıntısının uzun olması, C7 ve T1 kot arası fibröz bandlar, skalenus kas hipertrofisi ve bandları gibi nedenlerden klavikulanın psödoartrozisi, üst toraksa alınan darbeler, 1. kosta ve klavikula fraktürleri gibi travmatik nedenlerde tabloya neden olabilmektedir (1). Nörojenik ve vasküler (nonnörojenik) olmak üzere ikiye ayrılmaktadır (2).…”