Top

Published in:

Open Access 01-06-2019 | Thoracic Outlet Syndrome | Review

Thoracic Outlet Syndrome: A Comprehensive Review of Pathophysiology, Diagnosis, and Treatment

Authors: Mark R. Jones, Amit Prabhakar, Omar Viswanath, Ivan Urits, Jeremy B. Green, Julia B. Kendrick, Andrew J. Brunk, Matthew R. Eng, Vwaire Orhurhu, Elyse M. Cornett, Alan D. Kaye

Published in: Pain and Therapy | Issue 1/2019

Abstract

Thoracic outlet syndrome, a group of diverse disorders, is a collection of symptoms in the shoulder and upper extremity area that results in pain, numbness, and tingling. Identification of thoracic outlet syndrome is complex and a thorough clinical examination in addition to appropriate clinical testing can aide in diagnosis. Practitioners must consider the pathology of thoracic outlet syndrome in their differential diagnosis for shoulder and upper extremity pain symptoms so that patients are directed appropriately to timely therapeutic interventions. Patients with a definitive etiology who have failed conservative management are ideal candidates for surgical correction. This manuscript will discuss thoracic outlet syndrome, occurrence, physical presentation, clinical implications, diagnosis, and management.

Aljabri B, Al-Omran M. Surgical management of vascular thoracic outlet syndrome: a teaching hospital experience. Ann Vasc Dis. 2013;6(1):74–9. https://doi.org/10.3400/avd.oa.12.00081.CrossRefPubMedPubMedCentral

Laulan J, Fouquet B, Rodaix C, Jauffret P, Roquelaure Y, Descatha A. Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact. J Occup Rehabil. 2011;21(3):366–73. https://doi.org/10.1007/s10926-010-9278-9.CrossRefPubMedPubMedCentral

Freischlag J, Orion K. Understanding thoracic outlet syndrome. Scientifica (Cairo). 2014;2014:1–6. https://doi.org/10.1155/2014/248163.CrossRef

Citisli V. Assessment of diagnosis and treatment of thoracic outlet syndrome, an important reason of pain in upper extremity, based on literature. J Pain Relief. 2015;04(02):1–7. https://doi.org/10.4172/2167-0846.1000173.CrossRef

Maru S, Dosluoglu H, Dryjski M, Cherr G, Curl GR, Harris LM. Thoracic outlet syndrome in children and young adults. Eur J Vasc Endovasc Surg. 2009;38(5):560–4. https://doi.org/10.1016/j.ejvs.2009.06.015.CrossRefPubMed

Brooke BS, Freischlag JA. Contemporary management of thoracic outlet syndrome. Curr Opin Cardiol. 2010;25(6):535–40. https://doi.org/10.1097/HCO.0b013e32833f028e.CrossRefPubMed

Stewman C, Vitanzo PC, Harwood MI. Neurologic thoracic outlet syndrome: summarizing a complex history and evolution. Curr Sports Med Rep. 2014;13(2):100–6.CrossRef

Ferrante MA, Ferrante ND. The thoracic outlet syndromes: Part 2. The arterial, venous, neurovascular, and disputed thoracic outlet syndromes. Muscle Nerve. 2017;56(4):663–73. https://doi.org/10.1002/mus.25535.CrossRefPubMed

Raptis CA, Sridhar S, Thompson RW, Fowler KJ, Bhalla S. Imaging of the patient with thoracic outlet syndrome. RadioGraphics. 2016;36(4):984–1000. https://doi.org/10.1148/rg.2016150221.CrossRefPubMed

10.

Ferrante MA. The thoracic outlet syndromes. Muscle Nerve. 2012;45(6):780–95. https://doi.org/10.1002/mus.23235.CrossRefPubMed

11.

Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vasc Surg. 2007;46(3):601–4. https://doi.org/10.1016/j.jvs.2007.04.050.CrossRefPubMed

12.

Ibrahim R, Dashkova I, Williams M, et al. Paget–Schroetter syndrome in the absence of common predisposing factors: a case report. Thromb J. 2017;15:20. https://doi.org/10.1186/s12959-017-0146-0.CrossRefPubMedPubMedCentral

13.

Davis GA, Knight SR. Pancoast Tumors. Neurosurg Clin N Am. 2008;19(4):545–57. https://doi.org/10.1016/j.nec.2008.07.002.CrossRefPubMed

14.

Abdolrazaghi H, Riyahi A, Taghavi M, Farshidmehr P, Mohammadbeigi A. Concomitant neurogenic and vascular thoracic outlet syndrome due to multiple exostoses. Ann Card Anaesth. 2018;21(1):71–3. https://doi.org/10.4103/aca.ACA_119_17.CrossRefPubMedPubMedCentral

15.

Rutherford RB. Vascular Surgery. 6th ed. Saunders; 2005.

16.

Hooper TL, Denton J, McGalliard MK, Brismée J-M, Sizer PS. Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis. J Man Manip Ther. 2010;18(2):74–83. https://doi.org/10.1179/106698110x12640740712734.CrossRefPubMedPubMedCentral

17.

Demondion X, Herbinet P, Van Sint Jan S, Boutry N, Chantelot C, Cotten A. Imaging assessment of thoracic outlet syndrome. RadioGraphics. 2006;26(6):1735–50. https://doi.org/10.1148/rg.266055079.CrossRefPubMed

18.

Campbell WW, Landau ME. Controversial entrapment neuropathies. Neurosurg Clin N Am. 2008;19(4):597–608. https://doi.org/10.1016/j.nec.2008.07.001 (vi–vii).CrossRefPubMed

19.

Thompson RW. Comprehensive management of subclavian vein effort thrombosis. Semin Intervent Radiol. 2012;29(1):44–51. https://doi.org/10.1055/s-0032-1302451.CrossRefPubMedPubMedCentral

20.

Cooke RA. Thoracic outlet syndrome–aspects of diagnosis in the differential diagnosis of hand-arm vibration syndrome. Occup Med (Lond). 2003;53(5):331–6. http://www.ncbi.nlm.nih.gov/pubmed/12890833. Accessed 31 Mar 2019.

21.

Ingegnoli F, Gualtierotti R, Orenti A, et al. Uniphasic blanching of the fingers, abnormal capillaroscopy in nonsymptomatic digits, and autoantibodies: expanding options to increase the level of suspicion of connective tissue diseases beyond the classification of Raynaud’s phenomenon. J Immunol Res. 2015;2015:371960. https://doi.org/10.1155/2015/371960.CrossRefPubMedPubMedCentral

22.

Thompson R. Challenges in the treatment of thoracic outlet syndrome. Texas Hear Inst J. 2012;39(6):842–3. https://doi.org/10.1055/s-0032-1302451.pdf.CrossRef

23.

Sanders RJ, Hammond SL, Rao NM. Thoracic outlet syndrome. Neurologist. 2008;14(6):365–73. https://doi.org/10.1097/NRL.0b013e318176b98d.CrossRefPubMed

24.

Duwayri YM, Emery VB, Driskill MR, et al. Positional compression of the axillary artery causing upper extremity thrombosis and embolism in the elite overhead throwing athlete. J Vasc Surg. 2011;53(5):1329–40. https://doi.org/10.1016/j.jvs.2010.11.031.CrossRefPubMed

25.

William J, Molinari M, John C, Elfar M. The double crush syndrome. J Hand Surg Am. 2013;38(4):799–801. https://doi.org/10.1016/j.cogdev.2010.08.003.personal.CrossRef

26.

Upton ARM, Mccomas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973;302(7825):359–62. https://doi.org/10.1016/S0140-6736(73)93196-6.CrossRef

27.

Hurst LC, Weissberg D, Carroll RE. The relationship of the double crush to carpal tunnel syndrome (an analysis of 1000 cases of carpal tunnel syndrome). J Hand Surg Br. 1985;10(2):202–4.CrossRef

28.

Smith TM, Sawyer SF, Sizer PS, Brismée J-M. The double crush syndrome: a common occurrence in cyclists with ulnar nerve neuropathy—a case–control study. Clin J Sport Med. 2008;18(1):55–61. https://doi.org/10.1097/JSM.0b013e31815c1d7a.CrossRefPubMed

29.

Carroll RE, Hurst LC. The relationship of thoracic outlet syndrome and carpal tunnel syndrome. Clin Orthop Relat Res. 1982;164:149–53.

30.

Seror P. Frequency of neurogenic thoracic outlet syndrome in patients with definite carpal tunnel syndrome: an electrophysiological evaluation in 100 women. Clin Neurophysiol. 2005;116(2):259–63. https://doi.org/10.1016/j.clinph.2004.08.008.CrossRefPubMed

31.

Seror P. Symptoms of thoracic outlet syndrome in women with carpal tunnel syndrome. Clin Neurophysiol. 2005;116(10):2324–9. https://doi.org/10.1016/j.clinph.2005.06.016.CrossRefPubMed

32.

Narakas AOO. The role of thoracic outlet syndrome in the double crush syndrome. 1990;9(5):331–40. https://doi.org/10.1016/S0753-9053(05)80506-X.CrossRef

33.

Putters JL, Kaulesar Sukul DM, Johannes EJ. Bilateral thoracic outlet syndrome with bilateral radial tunnel syndrome: a double-crush phenomenon. Case report. Arch Orthop Trauma Surg. 1992;111(4):242–3.CrossRef

34.

Wood VE, Biondi J. Double-crush nerve compression in thoracic-outlet syndrome. J Bone Joint Surg Am. 1990;72(1):85–7.CrossRef

35.

Galarza M, Gazzeri R, Gazzeri G, Zuccarello M, Taha J. Cubital tunnel surgery in patients with cervical radiculopathy: double crush syndrome? Neurosurg Rev. 2009;32(4):471–8. https://doi.org/10.1007/s10143-009-0219-z.CrossRefPubMed

36.

Osterman AL. The double crush syndrome. Orthop Clin North Am. 1988;19(1):147–55.PubMed

37.

Kuhn JE, Lebus GF, Bible JE. Thoracic outlet syndrome. J Am Acad Orthop Surg. 2015;23(4):222–32. https://doi.org/10.5435/JAAOS-D-13-00215.CrossRefPubMed

38.

Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery. 2004;55(4):897–902 (discussion 902–3).CrossRef

39.

Narayanasamy N, Rastogi R. Thoracic outlet syndrome (TOS): an enigma in pain medicine. In: Kaye AD, Shah RV, editors. Case studies in pain management. Cambridge: Cambridge University Press; 2014. pp. 102–108. https://doi.org/10.1017/cbo9781107281950.014.

40.

Povlsen S, Povlsen B. Diagnosing thoracic outlet syndrome: current approaches and future directions. Diagnostics. 2018. https://doi.org/10.3390/diagnostics8010021.CrossRefPubMedPubMedCentral

41.

Gillard J, Pérez-Cousin M, Hachulla E, et al. Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine. 2001;68(5):416–24.CrossRef

42.

Le Forestier N, Moulonguet A, Maisonobe T, Léger JM, Bouche P. True neurogenic thoracic outlet syndrome: electrophysiological diagnosis in six cases. Muscle Nerve. 1998;21(9):1129–34.CrossRef

43.

Tsao BE, Ferrante MA, Wilbourn AJ, Shields RW. Electrodiagnostic features of true neurogenic thoracic outlet syndrome. Muscle Nerve. 2014;49(5):724–7. https://doi.org/10.1002/mus.24066.CrossRefPubMed

44.

Foley JM, Finlayson H, Travlos A. A review of thoracic outlet syndrome and the possible role of botulinum toxin in the treatment of this syndrome. Toxins (Basel). 2012;4(11):1223–35. https://doi.org/10.3390/toxins4111223.CrossRefPubMedPubMedCentral

45.

Finlayson HC, O’Connor RJ, Brasher PMA, Travlos A. Botulinum toxin injection for management of thoracic outlet syndrome: a double-blind, randomized, controlled trial. Pain. 2011;152(9):2023–8. https://doi.org/10.1016/j.pain.2011.04.027.CrossRefPubMed

46.

Burt BM. Thoracic outlet syndrome for thoracic surgeons. J Thorac Cardiovasc Surg. 2018;5:5. https://doi.org/10.1016/j.jtcvs.2018.02.096.CrossRef

47.

Vemuri C, McLaughlin LN, Abuirqeba AA, Thompson RW. Clinical presentation and management of arterial thoracic outlet syndrome. J Vasc Surg. 2017. https://doi.org/10.1016/j.jvs.2016.11.039.CrossRefPubMed

48.

Povlsen B, Hansson T, Povlsen SD. Treatment for thoracic outlet syndrome. Cochrane Database Syst Rev. 2014. https://doi.org/10.1002/14651858.cd007218.pub3.CrossRefPubMed

49.

Buller L, Jose J, Baraga M, Lesniak B. Thoracic outlet syndrome: current concepts, imaging features, and therapeutic strategies. Am J Orthop. 2015. https://doi.org/10.1212/wnl.0000000000002360.CrossRefPubMed

50.

Chang DC, Lidor AO, Matsen SL, Freischlag JA. Reported in-hospital complications following rib resections for neurogenic thoracic outlet syndrome. Ann Vasc Surg. 2007. https://doi.org/10.1016/j.avsg.2007.03.025.CrossRefPubMed

51.

Hosseinian MA, Loron AG, Soleimanifard Y. Evaluation of complications after surgical treatment of thoracic outlet syndrome. Korean J Thorac Cardiovasc Surg. 2017. https://doi.org/10.5090/kjtcs.2017.50.1.36.CrossRefPubMedPubMedCentral

52.

Urschel HC, Razzuk MA. Upper plexus thoracic outlet syndrome: optimal therapy. Ann Thorac Surg. 1997. https://doi.org/10.1016/s0003-4975(97)00188-4.CrossRefPubMed

53.

Schneider DB, Dimuzio PJ, Martin ND, et al. Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty. J Vasc Surg. 2004. https://doi.org/10.1016/j.jvs.2004.07.028.CrossRefPubMed

54.

Kevin Chang BEGKD, et al. Spectrum of thoracic outlet syndrome presentation in adolescents. JAMA Surg. 2011;146(12):1383–7.

55.

Emery, VB, Thompson RW. Thoracic outlet syndrome pathways of care and treatment options for patients with NTOS. London: Springer; 2013. https://doi.org/10.1007/978-1-4471-4366-6_22.

56.

Weaver M, Lum Y. New diagnostic and treatment modalities for neurogenic thoracic outlet syndrome. Diagnostics. 2017;7(2):28. https://doi.org/10.3390/diagnostics7020028.CrossRefPubMedCentral

57.

Magill ST, Brus-Ramer M, Weinstein PR, Chin CT, Jacques L. Neurogenic thoracic outlet syndrome: current diagnostic criteria and advances in MRI diagnostics. Neurosurg Focus. 2015;39(3):E7.CrossRef

58.

Filler A. Magnetic resonance neurography and diffusion tensor imaging: origins, history, and clinical impact of the first 50,000 cases with an assessment of efficacy and utility in a prospective 5000-patient study group. Neurosurgery. 2009. https://doi.org/10.1227/01.neu.0000351279.78110.00.CrossRefPubMedPubMedCentral

59.

Baumer P, Kele H, Kretschmer T, Koenig R, Pedro M, Bendszus M, Pham M. Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus. Eur Radiol. 2014;24:756–761. https://doi.org/10.1007/s00330-013-3060-2.CrossRefPubMed

60.

Illig KA, Donahue D, Duncan A, et al. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. J Vasc Surg. 2016;64(3):e23–35. https://doi.org/10.1016/J.JVS.2016.04.039&KEY=18346579&CF=.CrossRefPubMed

61.

Hwang J, Min B-J, Jo W-M, Shin JS. Video-assisted thoracoscopic surgery for intrathoracic first rib resection in thoracic outlet syndrome. J Thorac Dis. 2017;9(7):2022–8. https://doi.org/10.21037/jtd.2017.06.122.CrossRefPubMedPubMedCentral

Title: Thoracic Outlet Syndrome: A Comprehensive Review of Pathophysiology, Diagnosis, and Treatment
Authors: Mark R. Jones
Amit Prabhakar
Omar Viswanath
Ivan Urits
Jeremy B. Green
Julia B. Kendrick
Andrew J. Brunk
Matthew R. Eng
Vwaire Orhurhu
Elyse M. Cornett
Alan D. Kaye
Publication date: 01-06-2019
Publisher: Springer Healthcare
Keywords: Thoracic Outlet Syndrome
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Published in: Pain and Therapy / Issue 1/2019
Print ISSN: 2193-8237
Electronic ISSN: 2193-651X
DOI: https://doi.org/10.1007/s40122-019-0124-2

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Thoracic Outlet Syndrome: A Comprehensive Review of Pathophysiology, Diagnosis, and Treatment

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2019

An Update of Current Cannabis-Based Pharmaceuticals in Pain Medicine

The Relationship Between Musculoskeletal Pain and Picky Eating: The Role of Negative Self-Labeling

Efficacy and Safety of Combination of NSAIDs and Muscle Relaxants in the Management of Acute Low Back Pain

When the Best of Intentions Leads to Bad Outcomes

A Pulsed Electromagnetic Field Therapy Device for Non-Specific Low Back Pain: A Pilot Randomized Controlled Trial

The Role of Lofexidine in Management of Opioid Withdrawal

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page