Updated Perspectives on Neurogenic Thoracic Outlet Syndrome

Abstract

Pain represents a foremost feature of neurogenic thoracic outlet syndrome (NTOS). Similar to other persistent pain conditions, the physical discomfort associated with NTOS can cause severe and often debilitating symptoms. In fact, those suffering from the syndrome report a quality of life impacted as significantly as those with chronic heart failure. This evidence-based literature review focuses on the classification, etiology, clinical presentation, diagnostic measures, and surgical treatment of NTOS, with a focus on nonoperative therapies such as physical modalities, pharmacological therapies, and more contemporary minimally invasive intramuscular treatments with botulinum toxin.

Group IV nociceptors develop axonal chemical sensitivity during neuritis and following treatment of the sciatic nerve with vinblastine

“…Typical presentations include pain at rest and pain evoked by movements, especially movements that also move the nerves that innervate their painful area, implying altered neuronal function. These symptoms accompany a broad spectrum of disorders, such as back pain and lower limb pain with radiculopathy (Bove et al 2005;Waddell 1987), upper limb pain with neck injuries, thoracic outlet syndrome, radiation plexopathy (Christo and McGreevy 2011;Greening et al 2005;Olsen et al 1993), and endometriosis (Dhôte et al 1996;Missmer and Bove 2011).…”

Thoracic outlet syndrome: clinical and diagnostic features

“…Это позволяет ряду авто-ров выделять типы TOS по степени вовлечения стволов плечевого сплетения [7,9,30], но при этом есть мне-ние, что поражение верхних структур плечевого спле-тения встречается крайне редко [18].…”

“…Кроме стандартного неврологического осмотра с оценкой чувствительной и двигательной сфер, при подозрении на TOS рекомендуется проведение провокационных тестов [7,30,32,33]. К ним относят-ся проба Эдсона, разные маневры, уменьшающие ре-берно-ключичное пространство, гиперабдукционная проба (тест Райта), тест EAST (elevated arm stress test).…”

Botulinum Toxin Injections in Musculoskeletal Disorders

“…66 Preferential involvement of the brachial plexus, subclavian artery, or vein determines the type of TOS, with NTOS comprising > 95% of all TOS patients. 67 Because NTOS has an unclear pathophysiology, differentiation from other cervicobrachial pain syndromes is challenging. Clinical diagnosis is based on physical examination and exclusion of other conditions.…”