Thoracic outlet syndrome

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Thoracic outlet syndrome
The right brachial plexus, viewed from in front.
SpecialtyVascular surgery, thoracic surgery
SymptomsPain, weakness, loss of muscle at the base of the thumb, swelling, paleness, bluish coloration[1][2]
Usual onset20 to 50 years of age[1]
TypesNeurogenic, venous, arterial[1]
CausesCompression of the nerves, arteries, or veins in the superior thoracic aperture (thoracic outlet), the passageway from the lower neck to the armpit[1]
Risk factorsTrauma, repetitive arm movements, tumors, pregnancy, cervical rib[1]
Diagnostic methodNerve conduction studies, medical imaging[1]
Differential diagnosisRotator cuff tear, cervical disc disorders, fibromyalgia, multiple sclerosis, complex regional pain syndrome,[1] pectoralis minor syndrome[3]
TreatmentPain medication, surgery[1][2]
Frequency~1%[4]

Thoracic outlet syndrome (TOS) is a condition in which there is compression of the nerves, arteries, or veins in the superior thoracic aperture, the passageway from the lower neck to the armpit, also known as the thoracic outlet.[1] There are three main types: neurogenic, venous, and arterial.[1] The neurogenic type is the most common and presents with pain, weakness, paraesthesia, and occasionally loss of muscle at the base of the thumb.[1][2] The venous type results in swelling, pain, and possibly a bluish coloration of the arm.[2] The arterial type results in pain, coldness, and pallor of the arm.[2]

TOS may result from trauma, repetitive arm movements, tumors, pregnancy, or anatomical variations such as a cervical rib.[1] The diagnosis may be supported by nerve conduction studies and medical imaging.[1] TOS is difficult to diagnose and there are many potential differential diagnoses as well as other diseases that are often co-occurrent with TOS.[5]

Initial treatment for the neurogenic type is with exercises to strengthen the chest muscles and improve posture.[1] NSAIDs such as naproxen may be used for pain.[1] Surgery is typically done for the arterial and venous types and a decompression for the neurogenic type if it does not improve with other treatments.[1][2] Blood thinners may be used to treat or prevent blood clots.[1] The condition affects about 1% of the population.[4] It is more common in women than men and it occurs most commonly between 20 and 50 years of age.[1] The condition was first described in 1818 and the current term "thoracic outlet syndrome" first used in 1956.[2][6]

  1. ^ a b c d e f g h i j k l m n o p q r "NINDS Thoracic Outlet Syndrome Information Page". NINDS. December 28, 2011. Archived from the original on July 27, 2016. Retrieved August 19, 2016.
  2. ^ a b c d e f g Kuhn JE, Lebus V GF, Bible JE (April 2015). "Thoracic outlet syndrome". The Journal of the American Academy of Orthopaedic Surgeons. 23 (4): 222–32. doi:10.5435/jaaos-d-13-00215. PMID 25808686. S2CID 23150937.
  3. ^ Sanders, Richard J.; Rao, Neal M. (2010). "The Forgotten Pectoralis Minor Syndrome: 100 Operations for Pectoralis Minor Syndrome Alone or Accompanied by Neurogenic Thoracic Outlet Syndrome". Annals of Vascular Surgery. 24 (6): 701–708. doi:10.1016/j.avsg.2010.02.022. PMID 20471786.
  4. ^ a b Moore WS (2012). Vascular and Endovascular Surgery: A Comprehensive Review (8 ed.). Elsevier Health Sciences. p. 524. ISBN 978-1-4557-5386-4.
  5. ^ Povlsen, Sebastian; Povlsen, Bo (2018). "Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions". Diagnostics. 8 (1): 21. doi:10.3390/diagnostics8010021. PMC 5872004. PMID 29558408.
  6. ^ Lee JT, Jordan SE, Illig KA (2014). "Clinical incidence and prevalence: basic data on the current scope of the problem.". In Illig KA, Thompson RW, Freischlag JA, Donahue DM, Jordan SE, Edgelow PI (eds.). Thoracic Outlet Syndrome. London: Springer Science & Business Media. pp. 25–28. ISBN 978-1-4471-4366-6.