Thoracic-Outlet-Syndrom

Abstract

Thoracic outlet syndrome (TOS) is one of the most extensively discussed diagnoses. There is neither a clear and homogenous clinical presentation nor an accepted definition. The term describes a complex of symptoms and complaints caused by the compression of nerves and vascular structures at one of the three defined constrictions of the upper thoracic aperture. Based on a comprehensive literature review, this article presents the etiology, epidemiology and clinical diagnostics as well as the possibilities and outcomes of surgical treatment. The thoracic outlet syndrome is currently subdivided into three main forms: vascular TOS (vasTOS) including arterial TOS (aTOS) and venous TOS (vTOS), neurogenic TOS (nTOS), which is further subdivided into typical (nTOS) and atypical TOS (disTOS), and a mixed form of nTOS and vasTOS (nvasTOS). The diagnosis is complex and difficult since the disTOS group comprises over 90 % of all patients. In addition to conservative treatment attempts, nTOS may be treated by surgical procedures focusing on the decompression of neurovascular structures. A significant improvement after surgery was found in up to 92 % of cases. The most common access sites are supraclavicular and transaxillary. 50 to 80 % of patients benefit from surgery in the long run. The rates of vascular or neurological complications reported by specialised centres are 0 to 2 %; minor complications such as pneumothorax, bleeding and lymphatic fistula are reported in up to 25 % of cases. Most patients suffering from any form of TOS benefit from surgical treatment. Duration of symptoms, socioeconomic factors and, most notably, stringent diagnostic workup and an adequate operative procedure performed by an experienced centre are crucial to success.

Derkash's Classification and Vas Visual Analog Scale to Access the Long-Term Outcome of Neurothoracic Outlet Syndrome: A Meta-Analysis and Systematic Review

“…Therefore many surgical approaches for removing the first rib, especially complete or partial removal of the first rib became popular ( 32 , 33 ). TFRR achieved good results (48%), but the recurrence was still high (60%−70%) and often caused damage to the vessel and brachial plexus ( 34 ). Some studies showed that the NTOS was more likely to be related to the entrapment of the scalene muscles and bands on the brachial plexus.…”

The role of congenital malformations of the thoracic outlet in the development of the syndrome

“…To diagnose cervical ribs and anomalous first ribs one may use x-rays of the cervical spine and shoulder girdle and also CT, MR and electromyography. Patients present symptoms of venous obstruction, arterial insufficiency, paresthesia and pain [7,[10][11][12][13]. The therapy is often conservative, including exercises and physical therapy.…”

Axillary arch (of Langer): A large‐scale dissection and simulation study based on unembalmed cadavers of body donors

“…In the last decades, it became more and more evident that they might cause symptoms of thoracic outlet syndrome (TOS) (Besana‐Ciani & Greenall, 2005 ; Clarys et al., 1996 ; Georgiev et al., 2007 ; Hafner et al., 2010 ; Magee et al., 2012 ). TOS is characterized by paraesthesia, compressional pain, muscle weakness, oedema and thrombosis in the distal upper limbs (DiLosa & Humphries, 2021 ; Illig et al., 2021 ; Seifert et al., 2017 ; Stewman et al., 2014 ), and might be caused by compression of nerves and blood and lymph vessels (Besana‐Ciani & Greenall, 2005 ; Boontje, 1979 ; Mérida‐Velasco et al., 2003 ; Sachatello, 1977 ; Telisky & Olinger, 2011 ). The highest compressional intensity of axillary arches is supposed to occur in abducted and externally rotated arms.…”