Thoracic outlet syndrome: a review for the primary care provider

Angela C Cavanna, Athina Giovanis, Alton Daley, Ryan Feminella, Ryan Chipman, Valerie Onyeukwu, Angela C Cavanna, Athina Giovanis, Alton Daley, Ryan Feminella, Ryan Chipman, Valerie Onyeukwu

Abstract

Context: Thoracic outlet syndrome (TOS) symptoms are prevalent and often confused with other diagnoses. A PubMed search was undertaken to present a comprehensive article addressing the presentation and treatment for TOS.

Objectives: This article summarizes what is currently published about TOS, its etiologies, common objective findings, and nonsurgical treatment options.

Methods: The PubMed database was conducted for the range of May 2020 to September 2021 utilizing TOS-related Medical Subject Headings (MeSH) terms. A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) systematic literature review was conducted to identify the most common etiologies, the most objective findings, and the most effective nonsurgical treatment options for TOS.

Results: The search identified 1,188 articles. The automated merge feature removed duplicate articles. The remaining 1,078 citations were manually reviewed, with articles published prior to 2010 removed (n=771). Of the remaining 307 articles, duplicate citations not removed by automated means were removed manually (n=3). The other exclusion criteria included: non-English language (n=21); no abstracts available (n=56); and case reports of TOS occurring from complications of fractures, medical or surgical procedures, novel surgical approaches, or abnormal anatomy (n=42). Articles over 5 years old pertaining to therapeutic intervention (mostly surgical) were removed (n=18). Articles pertaining specifically to osteopathic manipulative treatment (OMT) were sparse and all were utilized (n=6). A total of 167 articles remained. The authors added a total of 20 articles that fell outside of the search criteria, as they considered them to be historic in nature with regards to TOS (n=8), were related specifically to OMT (n=4), or were considered sentinel articles relating to specific therapeutic interventions (n=8). A total of 187 articles were utilized in the final preparation of this manuscript. A final search was conducted prior to submission for publication to check for updated articles. Symptoms of hemicranial and/or upper-extremity pain and paresthesias should lead a physician to evaluate for musculoskeletal etiologies that may be contributing to the compression of the brachial plexus. The best initial provocative test to screen for TOS is the upper limb tension test (ULTT) because a negative test suggests against brachial plexus compression. A positive ULTT should be followed up with an elevated arm stress test (EAST) to further support the diagnosis. If TOS is suspected, additional diagnostic testing such as ultrasound, electromyography (EMG), or magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) might be utilized to further distinguish the vascular or neurological etiologies of the symptoms. Initial treatment for neurogenic TOS (nTOS) is often conservative. Data are limited, therefore there is no conclusive evidence that any one treatment method or combination is more effective. Surgery in nTOS is considered for refractory cases only. Anticoagulation and surgical decompression remain the treatment of choice for vascular versions of TOS.

Conclusions: The most common form of TOS is neurogenic. The most common symptoms are pain and paresthesias of the head, neck, and upper extremities. Diagnosis of nTOS is clinical, and the best screening test is the ULTT. There is no conclusive evidence that any one treatment method is more effective for nTOS, given limitations in the published data. Surgical decompression remains the treatment of choice for vascular forms of TOS.

Keywords: Paget-Schroetter syndrome; brachial plexus compression; cervical rib syndrome; shoulder hand syndrome; thoracic outlet syndrome.

© 2022 the author(s), published by De Gruyter, Berlin/Boston.

References

    1. Coote, ST. Bartholomew’s Hospital. Good recovery in the case of recent removal of an exostosis from the transverse process of one of the cervical vertebræ. Article. Lancet 1861;77:409. .
    1. Peet, RM, Henriksen, JD, Anderson, TP, Martin, GM. Thoracic-outlet syndrome: evaluation of a therapeutic exercise program. Proc Staff Meet Mayo Clin 1956;31:281–7.
    1. Otoshi, KSK, Kato, K, Sato, R, Igari, T, Kaga, T, Shishido, H, et al.. The prevalence and characteristics of thoracic outlet syndrome in high school baseball players. Health 2017;9:1223–34. .
    1. Zaorsky, M. Thoracic outlet. Available from: title=File:Wikipedia_medical_illustration_thoracic_outlet_syndrome_brachial_plexus_anatomy_with_labels.jpg&oldid=569109684.
    1. Sanders, R, Thoracic outlet syndrome: general considerations. Rutherford’s Vascular Surgery 9th Edition, chapter 120. Netherlands, Amsterdam: Elsevier Inc.; 2019:1607–18 pp.
    1. Jones, MR, Prabhakar, A, Viswanath, O, Uritis, I, Green, J, Kendrick, J, et al.. Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther 2019;8:5–18. .
    1. Hussain, MA, Aljabri, B, Al-Omran, M. Vascular thoracic outlet syndrome. Semin Thorac Cardiovasc Surg 2016;28:151–7. .
    1. Sanders, RJ, Hammond, SL, Rao, NM. Diagnosis of thoracic outlet syndrome. J Vasc Surg 2007;46:601–4. .
    1. Illig, KA, Donahue, D, Duncan, A, Freischlag, J, Gelabert, H, Johansen, K, et al.. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. J Vasc Surg 2016;64:e23-35. .
    1. Illig, KA, Rodriguez-Zoppi, E, Bland, T, Muftah, M, Jospitre, E. The incidence of thoracic outlet syndrome. Ann Vasc Surg 2021;70:263–72. .
    1. Abdallah, M, Wehbe, MR, Elias, E, Kutoubi, MA, Sfeir, R. Pectoralis minor syndrome: case presentation and review of the literature. Case Rep Surg 2016;2016:8456064. .
    1. Levine, NA, Rigby, BR. Thoracic outlet syndrome: biomechanical and exercise considerations. Healthcare 2018;6:68. .
    1. Sucher, BM, Heath, DM. Thoracic outlet syndrome--a myofascial variant: Part 3. Structural and postural considerations. J Am Osteopath Assoc 1993;93:340–5.
    1. Balderman, J, Holzem, K, Field, BJ, Bottros, M, Abuirqeba, V, et al.. Associations between clinical diagnostic criteria and pretreatment patient-reported outcomes measures in a prospective observational cohort of patients with neurogenic thoracic outlet syndrome. J Vasc Surg 2017;66:533–44.e2. .
    1. Povlsen, S, Povlsen, B. Diagnosing thoracic outlet syndrome: current approaches and future directions. Diagnostics 2018;8:92–101. .
    1. Atasoy, E. A hand surgeon’s further experience with thoracic outlet compression syndrome. J Hand Surg Am 2010;35:1528–38. .
    1. Hooper, TL, Denton, J, McGalliard, MK, Brismée, JM, Sizer, PSJr. Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis. J Man Manip Ther 2010;18:74–83. .
    1. Kuwayama, DP, Lund, JR, Brantigan, CO, Glebova, NO. Choosing surgery for neurogenic TOS: the roles of physical exam, physical therapy, and imaging. Diagnostics 2017;7:31–43. .
    1. Kuhn, JE, Lebus, VG, Bible, JE. Thoracic outlet syndrome. J Am Acad Orthop Surg 2015;23:222–32. .
    1. Sanders, RJ, Annest, SJ. Thoracic outlet and pectoralis minor syndromes. Semin Vasc Surg 2014;27:86–117. .
    1. Gillard, J, Pérez-Cousin, M, Hachulla, E, Remy, J, Hurtevent, JF, Vinckier, L, et al.. Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine 2001;68:416–24. .
    1. Sucher, BM. Thoracic outlet syndrome--a myofascial variant: Part 1. Pathology and diagnosis. J Am Osteopath Assoc 1990;90:686–96, 703–4.
    1. Dobrusin, R. An osteopathic approach to conservative management of thoracic outlet syndromes. J Am Osteopath Assoc 1989;89:1046–50, 1053–7.
    1. Weaver, ML, Lum, YW. New diagnostic and treatment modalities for neurogenic thoracic outlet syndrome. Diagnostics 2017;7:4–11. .
    1. Moriarty, JMBD, Broderick, DF, Cornelius, RS, Dill, KE, Francois, CJ, Gerhard-Herman, MD, et al.. ACR appropriateness criteria imaging in the diagnosis of thoracic outlet syndrome. J Am Coll Radiol 2015;12:438–43. .
    1. Raptis, CASS, Thompson, RW, Fowler, KJ, Bhalla, S. Imaging of the patient with thoracic outlet syndrome. Imaging of the patient with thoracic outlet syndrome. Radiographics 2016;36:984–1000. .
    1. Ghouri, MA, Gupta, N, Bhat, AP, Thimmappa, N, Saboo, S, Khandelwal, A, et al.. CT and MR imaging of the upper extremity vasculature: pearls, pitfalls, and challenges. Cardiovasc Diagn Ther 2019;9(1 Suppl):S152–73.. .
    1. Tsao, BE, Ferrante, MA, Wilbourn, AJ, Shields, RW. Electrodiagnostic features of true neurogenic thoracic outlet syndrome. Muscle Nerve 2014;49:724–7. .
    1. Ferrante, MA, Ferrante, ND. The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome. Muscle Nerve 2017;55:782–93. .
    1. Masocatto, NO, Da-Matta, T, Prozzo, TG, Couto, WJ, Porfirio, G. Thoracic outlet syndrome: a narrative review Síndrome do desfiladeiro torácico: uma revisão narrativa. Rev Col Bras Cir 2019;46:e20192243. .
    1. Sanders, RJ, Annest, SJ. Pectoralis minor syndrome: subclavicular brachial plexus compression. Diagnostics 2017;7:57–68. .
    1. Ligh, CA, Schulman, BL, Safran, MR. Case reports: unusual cause of shoulder pain in a collegiate baseball player. Clin Orthop Relat Res 2009;467:2744–8. .
    1. Ohman, JW, Thompson, RW. Thoracic outlet syndrome in the overhead athlete: diagnosis and treatment recommendations. Curr Rev Musculoskelet Med 2020;13:457–71. .
    1. Yagi, S, Mitsugi, M, Sangawa, T, Akaike, M, Sata, M. Paget-Schroetter syndrome in a baseball pitcher. Int Heart J 2017;58:637–40. .
    1. Lee, JH, Choi, HS, Yang, SN, Cho, WM, Lee, SH, Chung, HH, et al.. True neurogenic thoracic outlet syndrome following hyperabduction during sleep – a case report. Ann Rehabil Med 2011;35:565–9. .
    1. Alla, VM, Natarajan, N, Kaushik, M, Warrier, R, Nair, CK. Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. West J Emerg Med 2010;11:358–62.
    1. Aisen, PS, Aisen, ML. Shoulder-hand syndrome in cervical spinal cord injury. Paraplegia 1994;32:588–92. .
    1. Rosen, PS, Graham, W. The shoulder-hand syndrome: historical review with observations on seventy-three patients. Can Med Assoc J 1957;77:86–91.
    1. Laulan, J. Thoracic outlet syndromes. The so-called “neurogenic types”. Hand Surg Rehabil 2016;35:155–64. .
    1. Köknel Talu, G. Thoracic outlet syndrome. Agri 2005;17:5–9.
    1. Nichols, AW. Diagnosis and management of thoracic outlet syndrome. Curr Sports Med Rep 2009;8:240–9. .
    1. Rached, R, Hsing, W, Rached, C. Evaluation of the efficacy of ropivacaine injection in the anterior and middle scalene muscles guided by ultrasonography in the treatment of Thoracic Outlet Syndrome. Rev Assoc Med Bras 2019;65:982–7. .
    1. Hwang, JH, Ku, S, Jeong, JH. Traditional medicine treatment for thoracic outlet syndrome: a protocol for systematic review of randomized controlled trials. Medicine (Baltim) 2020;99: e21074. .
    1. Warrick, A, Davis, B. Neurogenic thoracic outlet syndrome in athletes – nonsurgical treatment options. Curr Sports Med Rep 2021;20:319–26. .
    1. Yuschak, E, Haq, F, Chase, S. A case of venous thoracic outlet syndrome: primary care review of physical exam provocative tests and osteopathic manipulative technique considerations. Cureus 2019;11:e4921. .
    1. Sucher, BM. Ultrasonography-guided osteopathic manipulative treatment for a patient with thoracic outlet syndrome. J Am Osteopath Assoc 2011;111:543–7. .
    1. Alvarez, DJ, Rockwell, PG. Trigger points: diagnosis and management. Am Fam Physician 2002;65:653–60.
    1. 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:E7. .
    1. Povlsen, BHT, Povlsen, SD. Treatment for thoracic outlet syndrome. Cochrane Database Syst Rev 2014;11:CD007218. .
    1. Lam, SKH, Reeves, KD, Cheng, AL. Transition from deep regional blocks toward deep nerve hydrodissection in the upper body and torso: method description and results from a retrospective chart review of the analgesic effect of 5% dextrose water as the primary hydrodissection injectate to enhance safety. BioMed Res Int 2017;2017:7920438.
    1. Kim, YW, Kim, Y, Kim, JM, Hong, JS, Lim, HS, Kim, HS. Is poststroke complex regional pain syndrome the combination of shoulder pain and soft tissue injury of the wrist? a prospective observational study: STROBE of ultrasonographic findings in complex regional pain syndrome. Medicine (Baltim) 2016;95:e4388. .
    1. Mowat, AG. Treatment of the shoulder-hand syndrome with corticosteroids. Ann Rheum Dis 1974;33:120–3. .
    1. Mall, NA, Van Thiel, GS, Heard, WM, Paletta, GA, Bush-Joseph, C, Bach, BRJr. Paget-schroetter syndrome: a review of effort thrombosis of the upper extremity from a sports medicine perspective. Sport Health 2013;5:353–6. .
    1. Hangge, P, Rotellini-Coltvet, L, Deipolyi, AR, Albadawi, H, Oklu, R. Paget-Schroetter syndrome: treatment of venous thrombosis and outcomes. Cardiovasc Diagn Ther 2017;7(3 Suppl):S285–90. .
    1. Lee, JTKJ, Harris, EJ, Haukoos, JS, Olcott C. Long-term thrombotic recurrence after nonoperative management of Paget-Schroetter syndrome. J Vasc Surg 2006;43:1236–43. .
    1. Moore, R, Wei Lum, Y. Venous thoracic outlet syndrome. Vasc Med 2015;20:182–9. .
    1. Hempel, GK, Shutze, WP, Anderson, JF, Bukhari, HI. 770 consecutive supraclavicular first rib resections for thoracic outlet syndrome. Ann Vasc Surg 1996;10:456–63. .
    1. Hooper, TL, Denton, J, McGalliard, MK, Brismée, JM, Sizer, PSJr. Thoracic outlet syndrome: a controversial clinical condition. Part 2: non-surgical and surgical management. J Man Manip Ther 2010;18:132–8. .
    1. Caputo, FJ, Wittenberg, AM, Vemuri, C, Driskill, M, Earley, J, Rastogi, R, et al.. Supraclavicular decompression for neurogenic thoracic outlet syndrome in adolescent and adult populations. J Vasc Surg 2013;57:149–57. .
    1. Terzis, JK, Kokkalis, ZT. Supraclavicular approach for thoracic outlet syndrome. Hand 2010;5:326–37. .
    1. Balderman, J, Abuirqeba, AA, Eichaker, L, Pate, C, Earley, J, Bottros, M, et al.. Physical therapy management, surgical treatment, and patient-reported outcomes measures in a prospective observational cohort of patients with neurogenic thoracic outlet syndrome. J Vasc Surg 2019;70:832–41. .
    1. Ferrante, MA, Ferrante, ND. The thoracic outlet syndromes: Part 2. The arterial, venous, neurovascular, and disputed thoracic outlet syndromes. Muscle Nerve 2017;56:663–73. .

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel