Thoracic outlet syndrome: a review

Panther, Eric; Reintgen, Christian D; Cueto, Robert; Hao, Kevin A.; Chim, Harvey; King, Joseph J.

doi:10.1016/j.jse.2022.06.026

Cited by 33 publications

(16 citation statements)

References 109 publications

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“…34 Compression over the supraclavicular region (also known as supraclavicular pressure test or Morley test) may reproduce pain and paresthesias. 47,48 A variety of special tests have been purported for the diagnosis of nTOS. The upper limb tension (Elvey) test and elevated arm stress (Roos) test are widely used, but are poorly specific for nTOS.…”

Section: Symptoms and Evaluationmentioning

confidence: 99%

“…The upper limb tension (Elvey) test and elevated arm stress (Roos) test are widely used, but are poorly specific for nTOS. 47 The Cyriax release test is performed with the patient seated with arms crossed across the chest with elbows flexed to 80 . The practitioner lifts the patient's shoulders from under the elbows, releasing tension on the brachial plexus.…”

Section: Symptoms and Evaluationmentioning

confidence: 99%

“…A positive Tinel sign about the interscalene triangle or supraclavicular region may be present 34 . Compression over the supraclavicular region (also known as supraclavicular pressure test or Morley test) may reproduce pain and paresthesias 47,48 . A variety of special tests have been purported for the diagnosis of nTOS.…”

Section: Brachial Plexopathymentioning

confidence: 99%

“…A variety of special tests have been purported for the diagnosis of nTOS. The upper limb tension (Elvey) test and elevated arm stress (Roos) test are widely used, but are poorly specific for nTOS 47 . The Cyriax release test is performed with the patient seated with arms crossed across the chest with elbows flexed to 80°.…”

Section: Brachial Plexopathymentioning

confidence: 99%

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Sports‐related peripheral nerve injuries of the upper limb

Dutton,

Norbury,

Colorado

2024

Muscle and Nerve

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Peripheral nerve injuries in athletes affect the upper limb more commonly than the lower limb. Common mechanisms include compression, traction, laceration, and ischemia. Specific sports can have unique mechanisms of injury and are more likely to be associated with certain neuropathies. Familiarity with these sport‐specific variables and recognition of the common presentations of upper limb neuropathic syndromes are important in assessing an athlete with a suspected peripheral nerve injury. Evaluation may require imaging modalities and/or electrodiagnostic testing to confirm a nerve injury. In some cases, diagnostic injections may be needed to differentiate neuropathic versus musculoskeletal etiology. Early and accurate diagnosis is essential for treatment/management and increases the likelihood of a safe return‐to‐sport and avoidance of long‐term functional consequences. Most nerve injuries can be treated conservatively, however, severe or persistent cases may require surgical intervention. This monograph reviews key diagnostic, management, and preventative strategies for sports‐related peripheral nerve injuries involving the upper limb.

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Section: Symptoms and Evaluationmentioning

confidence: 99%

Section: Symptoms and Evaluationmentioning

confidence: 99%

Section: Brachial Plexopathymentioning

confidence: 99%

Section: Brachial Plexopathymentioning

confidence: 99%

See 2 more Smart Citations

Sports‐related peripheral nerve injuries of the upper limb

Dutton,

Norbury,

Colorado

2024

Muscle and Nerve

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“…Inquire to determine whether injection at one anatomic site provided relief at adjacent sites Thoracic outlet syndrome Thoracic outlet syndrome (TOS) is a rare condition that occurs secondary to neurovascular plexus compression at the thoracic outlet, leading to a constellation of symptoms including arm pain, weakness, paresthesias, and/or hand swelling. 28 While multiple subtypes exist, brachial plexus compression results in neurogenic TOS. Owing to its nonspecific symptoms, neurogenic TOS can be especially challenging to diagnose.…”

Section: Diagnostic Injectionsmentioning

confidence: 99%

Differentiating Shoulder Pathology from Cervical Spine Pathology: An Algorithmic Approach

Brusalis,

Patel,

et al. 2023

J Am Acad Orthop Surg

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Accurate and timely diagnosis of musculoskeletal conditions is an essential component of high-quality orthopaedic care. The proximity of the shoulder to the cervical spine leads to a multitude of pathologic conditions whose clinical presentations overlap, posing a diagnostic challenge to orthopaedic providers. Missed or delayed diagnosis of the etiology for patient-described ‘shoulder pain’ causes frustration among patients, incurs increased healthcare costs, and delays treatment. Moreover, patients with concurrent conditions of the cervical spine and shoulder require deliberate consideration for how each condition contributes to patients' symptoms. The purpose of this review was to describe a systematic approach for evaluating and differentiating pathologies of the shoulder and cervical spine.

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Magnetic resonance neurography in the diagnosis of neurological subtypes of thoracic outlet syndrome

Davidson,

Tan,

Sneag

2024

Muscle and Nerve

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Neurological thoracic outlet syndrome (TOS) can be challenging to diagnose, particularly given its described subtypes of neurogenic TOS (NTOS) and disputed TOS (DTOS) that exhibit variable clinical presentations and etiologies. The diagnostic workup of TOS often includes magnetic resonance neurography (MRN) of the brachial plexus. Specific MRN imaging modifications for TOS evaluation are required to maximize spatial and contrast resolution to increase the conspicuity of nerve segments and their relationships to surrounding osseous structures. Dynamic assessment with arm positioning is used to evaluate outlet narrowing and compression of the plexus. Individual nerve segments are interrogated for their longitudinal and cross‐sectional morphologies and signal characteristics. In patients with NTOS, MRN may reveal focal impingement of the C8/T1 nerve roots and/or lower trunk with accompanying abnormal T2‐weighted signal hyperintensity. Predisposing anatomical entities include cervical ribs, rib synostoses, hypertrophic callous following clavicular fracture, remnant first thoracic rib from prior incomplete resection, and variable perineural scarring. In comparison, DTOS patients frequently demonstrate signal hyperintensity and enlargement of the mid plexus (trunk and division level), with narrowing of the costoclavicular interval. Following comprehensive diagnostic workup that frequently includes electrodiagnostic testing, patients are directed to different management pathways. Nonsurgical management is considered for all cases of DTOS; all patients with NTOS or DTOS who fail conservative treatment warrant referral for a surgical opinion. If surgery is pursued, MRN can be helpful in preoperative planning.

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Thoracic outlet syndrome: a review

Cited by 33 publications

References 109 publications

Sports‐related peripheral nerve injuries of the upper limb

Sports‐related peripheral nerve injuries of the upper limb

Differentiating Shoulder Pathology from Cervical Spine Pathology: An Algorithmic Approach

Magnetic resonance neurography in the diagnosis of neurological subtypes of thoracic outlet syndrome

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