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

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.

A Case Report on Paget-Schroetter Syndrome Presenting as Acute Localized Rhabdomyolysis

“…This patient likely had venous thoracic outlet syndrome, also known as Paget-Schroetter syndrome, which can present acutely when mechanical compression of stenosed veins from occult injury, repetitive movements of the arm, or stressful positioning results in stagnation of blood flow, and thus a subsequent "effort" thrombosis. 1 Although no definitive blood clot was identified on ultrasound or CT, it is postulated that the patient's acute symptomatology was due to a short-lived effort thrombosis of a chronically strictured axillary vein. This is evidenced by the elevated D-dimer, but limited given the lack of specificity of D-dimer for thrombosis.…”

“…Venous stenosis can present with a number of clinical symptoms, including swelling, pain, numbness, discoloration, and paresthesias. 1 These non-specific symptoms can often lead physicians to consider more common life-threatening conditions such as venous thrombosis, lymphedema, or inflammatory processes. Notably, the upper extremities are more commonly affected by venous stenosis than the lower extremities, and among the most common vein to be affected is the axillary vein.…”

Durchblutungsstörungen der oberen Extremitäten

“…Die obere Thoraxapertur ist eine anatomische Enge für die hier durchziehenden vaskulären und nervalen Strukturen [10]. Das Thoracic-outlet-Syndrom (TOS) mit Kompression der A. subclavia zwischen der Klavikula und der ersten Rippe oder einer Halsrippe kann zu schweren Durchblutungsstörungen des Armes führen.…”

Top-Ten Tips for Imaging the Brachial Plexus with Ultrasound and MRI

“…Overall, nTOS accounts for $ 95% of TOS, occurring particularly in women 20 to 40 years of age. 47 Symptoms of nTOS include pain, numbness, and tingling typically of the proximal arm, often aggravated by overhead reaching or arm extension. 47 Color or temperature changes can occur, but swelling is uncommon.…”

“…47 Symptoms of nTOS include pain, numbness, and tingling typically of the proximal arm, often aggravated by overhead reaching or arm extension. 47 Color or temperature changes can occur, but swelling is uncommon. Preliminary diagnostic criteria for nTOS were published in 2014.…”