The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome

Abstract

The thoracic outlet syndromes (TOSs) are a group of etiologically and clinically distinct disorders with 1 feature in common: compression of 1 or more neurovascular elements as they traverse the thoracic outlet. The medical literature reflects 5 TOSs: arterial; venous; traumatic neurovascular; true neurogenic; and disputed. Of these, the first 4 demonstrate all of the features expected of a syndrome, whereas disputed TOS does not, causing many experts to doubt its existence altogether. Thus, some categorize disputed TOS as a cervicoscapular pain syndrome rather than as a type of TOS. To better understand these disorders, their distinctions, and the reasoning underlying the categorical change of disputed TOS from a form of TOS to a cervicoscapular pain syndrome, a thorough understanding of the pertinent anatomy, pathology, pathophysiology, and the electrodiagnostic manifestations of their pathophysiologies is required. This review of the TOSs is provided in 2 parts. In this first part we address information pertinent to all 5 TOSs and reviews true neurogenic TOS. In part 2 we review the other 4 TOSs. Muscle Nerve 55: 782-793, 2017.

Upper Limb Pain and Paresthesia in a Post-Stroke Patient Treated with Ultrasound-Guided Electrical Twitch-Obtaining Intramuscular Stimulation (ETOIMS) of Scalene Muscles

“…Brain & NeuroRehabilitation https://e-bnr.org group of disorders, with one study describing 5 entities as TOSs: arterial TOS, venous TOS, traumatic neurovascular TOS, true neurogenic TOS (TN-TOS), and disputed TOS [11]. Of these, neurogenic TOS was reported to be more common than vascular TOS, comprising over 90% of all TOS cases [12].…”

“…Of these, neurogenic TOS was reported to be more common than vascular TOS, comprising over 90% of all TOS cases [12]. However, in that series, disputed TOS represented 99% of the neurogenic TOSs [11]. Also, there is controversy regarding disputed TOS because of its uncertain pathogenesis, unclear clinical presentation, and variable evaluation tools.…”

Thoracic outlet syndrome: clinical and diagnostic features

“…Ней-рогенный тип TOS подразделяют на истинный нейро-генный (когда поражение нервных структур подтвер-ждается клинически или данными инструментальных исследований) и спорный нейрогенный (neurogenic disputed, когда при наличии жалоб на чувствительные нарушения они никак не подтверждаются объектив-но). Некоторые авторы также выделяют 5-й вариант -травматический нейроваскулярный TOS [16].…”

“…К самым частым жалобам при спор-ном TOS относятся боль (88 %), онемение (98 %) и слабость мышц (55 %) всей верхней конечности [11,18]. Эти симптомы могут наблюдаться в покое, однако чаще провоцируются и усиливаются при определен-ном ее положении, в частности при подъеме выше уровня плеча или при удержании тяжелых предметов в вытянутой вниз руке [16,18]. Боль и чувствительные нарушения чаще распространяются по локтевой сто-роне кисти, что является важным клиническим при-знаком нейрогенного TOS [10].…”

Compression of the neurovascular bundle above and below the clavicle

“…The venous type results in swelling, pain, and sometimes bluish discoloration of the arm. The arterial type results in pain, coldness, and paleness of the arm [1,2,3].…”