Thoracic outlet syndrome

Diagnosis and treatment of thoracic outlet syndrome (TOS) involves neurologists, physiatrists, family physicians, orthopedic surgeons, vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists. It is generally accepted that TOS is caused by compression of brachial plexus elements or subclavian vessels in their passage from the cervical area toward the axilla and proximal arm either at the interscalene triangle, the costoclavicular triangle, or the subcoracoid space. Cervical ribs, anomalous muscles, and fibrous bands may further constrict these areas. Patients with thoracic outlet syndrome usually have aching type pain radiating from their scapula down the upper extremity. It is more common in women, and between 20 and 50 years of age. In order to diagnose accurately, clinical presentation may be evaluated as neurogenic TOS, those with compression of the brachial plexus, or vascular TOS, those with compression of the subclavian vessels and nonspecific-type TOS. The diagnosis of TOS can be made by history, physical examination, provocative tests, ultrasound, radiological evaluation and electrodiagnostic evaluation. For most patients with TOS, conservative treatment is offered. Definitive treatment involves surgical decompression of the related structures.