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

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, 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

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.

Keywords: Brachial plexus; Neurogenic thoracic outlet syndrome; Subclavian vein; Thoracic outlet syndrome.

Figures

Fig. 1
Fig. 1
Thoracic outlet and relevant anatomy

References

    1. Aljabri B, Al-Omran M. Surgical management of vascular thoracic outlet syndrome: a teaching hospital experience. Ann Vasc Dis. 2013;6(1):74–79.
    1. 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):366–373.
    1. Freischlag J, Orion K. Understanding thoracic outlet syndrome. Scientifica (Cairo). 2014;2014:1–6.
    1. 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.
    1. 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):560–564.
    1. Brooke BS, Freischlag JA. Contemporary management of thoracic outlet syndrome. Curr Opin Cardiol. 2010;25(6):535–540.
    1. Stewman C, Vitanzo PC, Harwood MI. Neurologic thoracic outlet syndrome: summarizing a complex history and evolution. Curr Sports Med Rep. 2014;13(2):100–106.
    1. Ferrante MA, Ferrante ND. The thoracic outlet syndromes: Part 2. The arterial, venous, neurovascular, and disputed thoracic outlet syndromes. Muscle Nerve. 2017;56(4):663–673.
    1. Raptis CA, Sridhar S, Thompson RW, Fowler KJ, Bhalla S. Imaging of the patient with thoracic outlet syndrome. RadioGraphics. 2016;36(4):984–1000.
    1. Ferrante MA. The thoracic outlet syndromes. Muscle Nerve. 2012;45(6):780–795.
    1. Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vasc Surg. 2007;46(3):601–604.
    1. 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.
    1. Davis GA, Knight SR. Pancoast Tumors. Neurosurg Clin N Am. 2008;19(4):545–557.
    1. 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):71–73.
    1. Rutherford RB. Vascular Surgery. 6th ed. Saunders; 2005.
    1. 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.
    1. Demondion X, Herbinet P, Van Sint Jan S, Boutry N, Chantelot C, Cotten A. Imaging assessment of thoracic outlet syndrome. RadioGraphics. 2006;26(6):1735–1750.
    1. Campbell WW, Landau ME. Controversial entrapment neuropathies. Neurosurg Clin N Am. 2008;19(4):597–608.
    1. Thompson RW. Comprehensive management of subclavian vein effort thrombosis. Semin Intervent Radiol. 2012;29(1):44–51.
    1. 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. . Accessed 31 Mar 2019.
    1. 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.
    1. Thompson R. Challenges in the treatment of thoracic outlet syndrome. Texas Hear Inst J. 2012;39(6):842–843.
    1. Sanders RJ, Hammond SL, Rao NM. Thoracic outlet syndrome. Neurologist. 2008;14(6):365–373.
    1. 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):1329–1340.
    1. William J, Molinari M, John C, Elfar M. The double crush syndrome. J Hand Surg Am. 2013;38(4):799–801.
    1. Upton ARM, Mccomas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973;302(7825):359–362.
    1. 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):202–204.
    1. 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.
    1. Carroll RE, Hurst LC. The relationship of thoracic outlet syndrome and carpal tunnel syndrome. Clin Orthop Relat Res. 1982;164:149–153.
    1. 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):259–263.
    1. Seror P. Symptoms of thoracic outlet syndrome in women with carpal tunnel syndrome. Clin Neurophysiol. 2005;116(10):2324–2329.
    1. Narakas AOO. The role of thoracic outlet syndrome in the double crush syndrome. 1990;9(5):331–340.
    1. 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):242–243.
    1. Wood VE, Biondi J. Double-crush nerve compression in thoracic-outlet syndrome. J Bone Joint Surg Am. 1990;72(1):85–87.
    1. 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):471–478.
    1. Osterman AL. The double crush syndrome. Orthop Clin North Am. 1988;19(1):147–155.
    1. Kuhn JE, Lebus GF, Bible JE. Thoracic outlet syndrome. J Am Acad Orthop Surg. 2015;23(4):222–232.
    1. Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery. 2004;55(4):897–902.
    1. 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. 10.1017/cbo9781107281950.014.
    1. Povlsen S, Povlsen B. Diagnosing thoracic outlet syndrome: current approaches and future directions. Diagnostics. 2018
    1. 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):416–424.
    1. 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):1129–1134.
    1. Tsao BE, Ferrante MA, Wilbourn AJ, Shields RW. Electrodiagnostic features of true neurogenic thoracic outlet syndrome. Muscle Nerve. 2014;49(5):724–727.
    1. 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):1223–1235.
    1. 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):2023–2028.
    1. Burt BM. Thoracic outlet syndrome for thoracic surgeons. J Thorac Cardiovasc Surg. 2018;5:5.
    1. Vemuri C, McLaughlin LN, Abuirqeba AA, Thompson RW. Clinical presentation and management of arterial thoracic outlet syndrome. J Vasc Surg. 2017
    1. Povlsen B, Hansson T, Povlsen SD. Treatment for thoracic outlet syndrome. Cochrane Database Syst Rev. 2014
    1. Buller L, Jose J, Baraga M, Lesniak B. Thoracic outlet syndrome: current concepts, imaging features, and therapeutic strategies. Am J Orthop. 2015
    1. Chang DC, Lidor AO, Matsen SL, Freischlag JA. Reported in-hospital complications following rib resections for neurogenic thoracic outlet syndrome. Ann Vasc Surg. 2007
    1. Hosseinian MA, Loron AG, Soleimanifard Y. Evaluation of complications after surgical treatment of thoracic outlet syndrome. Korean J Thorac Cardiovasc Surg. 2017
    1. Urschel HC, Razzuk MA. Upper plexus thoracic outlet syndrome: optimal therapy. Ann Thorac Surg. 1997
    1. 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
    1. Kevin Chang BEGKD, et al. Spectrum of thoracic outlet syndrome presentation in adolescents. JAMA Surg. 2011;146(12):1383–1387.
    1. Emery, VB, Thompson RW. Thoracic outlet syndrome pathways of care and treatment options for patients with NTOS. London: Springer; 2013. 10.1007/978-1-4471-4366-6_22.
    1. Weaver M, Lum Y. New diagnostic and treatment modalities for neurogenic thoracic outlet syndrome. Diagnostics. 2017;7(2):28.
    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(3):E7.
    1. 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
    1. 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.
    1. 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–e35.
    1. 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):2022–2028.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel