Materiały źródłowe

• #1 Overview of thoracic outlet syndromes – UpToDate

  https://www.uptodate.com/contents/overview-of-thoracic-outlet-syndromes

  Thoracic outlet syndrome (TOS) refers to a constellation of signs and symptoms that arise from compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle, within the confined space of the thoracic outlet. […] Distinct terms are used to describe the predominantly affected structure, including neurogenic (nTOS) from brachial plexus compression, venous (vTOS) from subclavian vein compression, and arterial (aTOS) from subclavian artery compression. […] Neurogenic TOS accounts for greater than 95 percent of cases of thoracic outlet syndrome, whereas vTOS accounts for 3 percent and aTOS accounts for 1 percent of cases. […] An overview of the anatomy, pathogenesis, clinical evaluation, and approach to the management of the thoracic outlet syndromes will be reviewed with an emphasis on the features that distinguish these syndromes from one another. […] The thoracic outlet is bounded by the bony structures of the spinal column, first ribs, and sternum. […] Compromise of the neurovascular structures that traverse the thoracic outlet occurs in three distinct spaces: the scalene triangle, the costoclavicular space, and the pectoralis minor space.

• #1 Thoracic outlet syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/diagnosis-treatment/drc-20353994

  How is thoracic outlet syndrome (TOS) diagnosed? […] It’s important to have a correct diagnosis for a thoracic outlet as this will determine what type of therapy and treatment is implemented. It’s typically an exclusion of diagnosis, and this process starts with physical examination and good history, followed by imaging studies, vascular studies, provocative tests, and consultation with a multidisciplinary team in order to exclude what’s usually more common. […] Diagnosing thoracic outlet syndrome can be challenging. Symptoms can vary greatly among people. Your healthcare professional may review your symptoms and medical history and conduct a physical exam. You also may need imaging and other types of tests. […] Your healthcare professional does a physical exam to look for signs of thoracic outlet syndrome. These may include a depression in your shoulder or a bony area above the collarbone. Your healthcare professional also may look for swelling or a change in color in your arm. You may need to have your pulse and your range of motion checked.

• #1 Thoracic Outlet Syndrome Diagnosis: An Expert’s Perspective

  https://kamranaghayev.com/thoracic-outlet-syndrome-diagnosis/

  Thoracic outlet syndrome diagnosis is difficult because there is no universal confirmatory test. An important part of diagnosis comes from recognizing TOS as a possible cause of the patients problems. […] If thoracic outlet syndrome is suspected, the diagnosis is actually more likely to be accurate. […] Suspecting TOS is the first step, but many tests must be performed to confirm the diagnosis. […] Diagnosing TOS is like putting the pieces of a puzzle together. […] A careful history and physical examination are important keys to suspecting thoracic outlet syndrome. […] Poor posture carries risk for TOS development and I always check postural abnormalities. […] Pain and tenderness at the junction of the neck and shoulder area is very typical but not specific to TOS. […] The neurological examination should focus on muscle weakness and sensory disturbances in the arms and hands.

• #1 The diagnosis of thoracic outlet syndrome | JVD

  https://www.dovepress.com/the-diagnosis-of-thoracic-outlet-syndrome-peer-reviewed-fulltext-article-JVD

  „Thoracic outlet syndrome” is a term that covers a range of conditions and abnormalities causing a variety of presentations and symptoms. […] There is no single test available for the definitive diagnosis and assessment of this group of conditions. […] Diagnosing thoracic outlet syndrome (TOS) is clinically challenging. […] This article aims to outline the background and anatomy of TOS and provide an up-to-date review of the clinical and imaging assessment of this condition. […] Diagnosing TOS is challenging, as symptoms can be chronic and overlap with other presentations. […] A variety of dynamic provocation tests can reproduce the symptoms from TOS. […] Although these tests may be used at initial clinical assessment, they all have high false-positive rates. […] The use of anesthetic blocks of the anterior scalene and pectoralis minor muscles, both as diagnostic and therapeutic maneuvers, has increased in recent years.

• #1 Thoracic Outlet Syndrome Diagnosis: An Expert’s Perspective

  https://kamranaghayev.com/thoracic-outlet-syndrome-diagnosis/

  Muscle wasting is particularly important because it is an indicator of the severity of the disease. […] All hand muscles receive innervation from the lower part of brachial plexus specifically by C8 and T1 nerve roots. […] Neurogenic TOS causes variety of sensory disturbances. […] Correct sensory examination can significantly contribute to TOS diagnosis. […] Provocative testing is an essential part of clinical examination. […] Elevated arm stress test (EAST or Roos test). It is most commonly used and most informative test for diagnosing TOS. […] This is a very useful tool for diagnosing simple bone abnormalities. […] CT angiography (CTA) is perfect for subclavian artery and vein visualization. […] High-resolution USG of the thoracic outlet area can directly demonstrate the neuro-vascular bundle compression.

• #1 Thoracic Outlet Syndrome Tests

  https://www.carpalrx.com/thoracic-outlet-syndrome-tests

  The tests below are identical to what a doctor will give you for thoracic outlet syndrome. […] By doing these tests, you can eliminate thoracic outlet syndrome as the possible cause of your symptoms. […] A positive sign will be pain, heaviness or intense arm weakness or numbness, and perhaps tingling in your hand. […] A positive sign will be disappearance of your radial pulse. […] A positive sign is an absence of your radial pulse. […] A positive sign is if your radial pulse disappears as your head is rotated. […] A positive sign for thoracic outlet syndrome is when your arms, hands or fingers go from numbness to pins-and-needles (or tingling) as well as some pain. […] One or more positive signs in these 5 tests may mean you have thoracic outlet syndrome.

• #1 Neurological Thoracic Outlet Syndrome Diagnosis | nTOS

  https://www.physiotutors.com/wiki/neurological-thoracic-outlet-syndrome/

  The treatment of neurogenic thoracic outlet syndrome, abbreviated as nTOS has been hampered by inconsistent definitions and diagnosis which leads to uncertainty regarding treatment options and a lack of consistent outcome measures Illig et al. (2016) of the Society for Vascular Surgery published reporting standards for TOS with the primary aim to provide a clear and consistent understanding and definition of what constitutes a diagnosis of nTOS. Following these criteria, nTOS should be defined by the presence of three of the following four: […] It has to be said that the subjective nature of many of these diagnostic findings contributes to the controversy surrounding the validity of the diagnosis of nTOS. […] Common tests to assess for TOS are: Adson Test, Eden/Military Brace Test, Wrights Test, Tinels Sign, Morley / Brachial Plexus Compression Test, Cyriax Release Test, Costoclavicular Maneuver / Halstead Test.

• #1 How to truly identify and treat thoracic outlet syndrome (TOS) – MSK Neurology

  https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/

  With regards to diagnosis of N-TOS, it has been shown that EMG, NCV and MR neurographies are not reliable diagnostic criteria. […] Findings showed denervation activity, increased mean action potential amplitude, and/or duration and reduced recruitment at maximum effort. However, there is still some question as to whether EMG is adequately sensitive to detect changes in NTOS patients with milder symptoms. […] Somatosensory evoked potentials (SEPs) are used in the diagnosis of thoracic outlet syndrome (TOS), even as an indication for surgery. […] The interscalene triangle is usually the main entrapment point (culprit), and will often stand for 60-80% of the patients symptoms. […] To evaluate the scalenes involvement, the therapist pushes the thumb into the brachial plexus, in the middle of the distal anterior and middle scalene fibers.

• #1 Thoracic Outlet Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/thoracic-outlet-syndrome/

  Thoracic outlet syndrome (TOS) refers to a constellation of upper extremity symptoms from compression of neurovascular structures coursing through the thoracic inlet. […] Accurate diagnosis and incidence of TOS is difficult due to the absence of consistently reproducible objective measures. […] It is important to evaluate for mimics of TOS in diagnostic phase. Differential diagnosis includes C8-T1 radiculopathy, brachial plexopathy, carpal tunnel syndrome, ulnar neuropathy, intrinsic shoulder pathology, cubital tunnel syndrome, quadrilateral space syndrome and myofascial pain. […] The current provocative special tests used to diagnose TOS have low specificity and thus, high false positive rates. […] Studies indicate that utilizing multiple tests in conjunction may increase the specificity of TOS identification.

• #1 Thoracic outlet syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/diagnosis-treatment/drc-20353994

  To confirm the diagnosis of thoracic outlet syndrome, you may need one or more of the following tests: […] An ultrasound uses sound waves to create images of your body. It’s often the first imaging test used to help diagnose thoracic outlet syndrome. […] An X-ray can reveal an extra rib, known as a cervical rib. […] A CT scan uses X-rays to get cross-sectional images of your body. […] An MRI uses radio waves and magnetic fields to create a detailed view of your body. […] During an EMG, a needle electrode is inserted through your skin into various muscles. The test checks the electrical activity of your muscles when they contract and when they’re at rest. This test can determine if you have nerve damage.

• #1 Neurogenic thoracic outlet syndrome: current diagnostic criteria and advances in MRI diagnostics in: Neurosurgical Focus Volume 39 Issue 3 (2015) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/39/3/article-pE7.xml

  Neurogenic thoracic outlet syndrome (nTOS) is caused by compression of the brachial plexus as it traverses from the thoracic outlet to the axilla. Diagnosing nTOS can be difficult because of overlap with other complex pain and entrapment syndromes. An nTOS diagnosis is made based on patient history, physical exam, electrodiagnostic studies, and, more recently, interpretation of MR neurograms with tractography. […] Advances in high-resolution MRI and tractography can confirm an nTOS diagnosis and identify the location of nerve compression, allowing tailored surgical decompression. […] The authors conclude that improved high-resolution MRN and tractography are valuable tools for identifying the source of nerve compression in patients with nTOS and can augment current diagnostic modalities for this syndrome.

• #1 Diagnosis of thoracic outlet syndrome with the lower trunk compression of brachial plexus by high-frequency ultrasonography | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06762-7

  Thoracic outlet syndrome (TOS) with the lower trunk compression of brachial plexus (BP) is difficult to diagnosis. This study aimed to summarize the features of thoracic outlet syndrome (TOS) with the lower trunk compression of brachial plexus observed on high-frequency ultrasonography (HFUS). […] The ultrasound data of 27 patients who had TOS with the lower trunk compression of brachial plexus were collected and eventually confirmed by surgery. […] TOS with the lower trunk compression of brachial plexus can be diagnosed accurately and reliably by high-frequency ultrasound. […] At present, the diagnosis of TOS with the lower trunk compression of brachial plexus commonly relies on electromyography (EMG), CT and magnetic resonance imaging (MRI), in addition to medical history and clinical examinations.

• #1 Thoracic Outlet Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557450/

  Electrodiagnostic studies (EMS) are a classic diagnostic mode to diagnose neurogenic TOS. […] The physical exam, in a patient with suspected TOS, is crucial to confirming the diagnosis and pinpointing the etiology. […] The roos stress test can help to test for any variant of TOS. […] A positive result is considered a reduction of less than 85 m/s, and an overall velocity of less than 60 m/s is regarded as an indication for surgery.

• #1 Thoracic Outlet Syndrome: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/96412-overview

  Thoracic outlet syndrome is not the name of a single entity but rather a collective title for a variety of conditions attributed to the compression of neurovascular structures as they traverse the thoracic outlet. […] Thoracic outlet syndrome remains one of the most controversial clinical entities in medicine. […] To exclude systemic disease and inflammation, a few simple blood tests may refine the differential diagnosis for thoracic outlet syndrome, including a blood glucose level, complete blood cell (CBC) count, erythrocyte sedimentation rate (ESR), basic metabolic panel, thyrotropin level, and rheumatologic workup, if indicated. […] Imaging studies that can be used in the diagnosis of thoracic outlet syndrome include the following: Radiography, Computed tomography (CT) scanning and magnetic resonance imaging (MRI) – Useful for identifying other conditions that might cause similar symptoms, Magnetic resonance angiography (MRA), Venography and duplex scanning. […] Electrodiagnostic studies can be helpful in classic cases of neurogenic thoracic outlet syndrome. However, many symptoms are intermittent in this disorder; therefore, negative test results do not rule out the diagnosis.

• #1 Thoracic Outlet Syndrome Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/96412-workup

  CT scanning and MRI are more useful for identifying other conditions that might cause similar symptoms, rather than for establishing the diagnosis of thoracic outlet syndrome. […] MRA can be useful for the diagnosis of arterial vascular thoracic outlet syndrome. […] Venography and duplex scanning (ie, ultrasonography combined with Doppler velocity waveforms) are used to assist in the diagnosis of subclavian vein compression (thrombosis). […] Electrodiagnostic studies can be helpful for classic cases of neurogenic thoracic outlet syndrome and therefore can be useful when the results are positive. […] Nerve conduction velocity has been used for the diagnosis of thoracic outlet syndrome as defined by a reduction to less than 85 m/s of either the ulnar or median nerves across the thoracic outlet and was found to corroborate the clinical diagnosis.

• #1 Thoracic Outlet Syndrome Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/96412-workup

  However, as with many aspects of thoracic outlet syndrome, this remains controversial and has not been universally accepted. […] Somatosensory evoked potentials are equally controversial, with some studies favoring their use and others not. […] Electromyography may be helpful in confirming the presence or absence of a specific alternative diagnosis. […] A study reported that intravascular ultrasound detected greater levels of stenosis than venography in the treatment of 14 venous thoracic outlet syndrome patients.

• #1 Diagnosing Thoracic Outlet Syndrome | NYU Langone Health

  https://nyulangone.org/conditions/thoracic-outlet-syndrome/diagnosis

  Your NYU Langone doctor may order this test even if a chest X-ray indicates there are no problems with the thoracic outlet. […] An MRI scan uses a magnetic field and radio waves to create computerized, 2D and 3D images of the body. It helps doctors determine if any chest veins and arteries are blocked or compressed. […] In this test, a contrast dye is injected into the arteries or veins, enabling your doctor to clearly see any blockages.

• #1 The diagnosis of thoracic outlet syndrome | JVD

  https://www.dovepress.com/the-diagnosis-of-thoracic-outlet-syndrome-peer-reviewed-fulltext-article-JVD

  The use of electromyography and nerve conduction studies in diagnosing TOS is controversial. […] X-ray of the cervical spine and chest are the first imaging investigations for TOS. […] The decision to investigate further will depend upon the presentation, history, and clinical findings. […] DSA has been regarded as the gold standard investigation for arterial abnormalities. […] Modern cross-sectional imaging techniques are very effective in demonstrating vascular pathologies such as impingement or obstruction and have the advantage of being much less invasive. […] MRI is increasingly used in the diagnosis of vascular TOS. […] There is still controversy over the use of MRI for neurogenic TOS. […] Appropriate investigations need to be tailored to the individual and there is no single diagnostic test. […] Clinical history and examination dictates the need for electrophysiological testing and subsequent imaging.

• #1 Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5872004/

  Once a diagnosis of TOS is suspected on clinical grounds, it is important to characterise the anatomy of the thoracic outlet, particularly with respect to potential sources of compression, as this can guide management approaches, especially if surgery is to be considered. […] In diagnosing VTOS, duplex ultrasound is typically employed if thrombosis is suspected, with very high sensitivity and specificity of 78-100% and 82-100%, respectively. […] NTOS is a field where the contribution of diagnostic investigations is certainly changing. […] Another testing modality suggested by the Society for Vascular Surgery is to inject the scalene and pectoralis minor muscles with local anaesthetic to check for alleviation of symptoms, the rationale being that the scalene triangle and pectoralis minor space are common sites of compression.

• #1 Diagnostic and Therapeutic Approach to Thoracic Outlet Syndrome

  https://www.mdpi.com/2379-139X/10/9/103

  Thoracic outlet syndrome (TOS) is a group of symptoms caused by the compression of neurovascular structures of the superior thoracic outlet. The knowledge of its clinical presentation with specific symptoms, as well as proper imaging examinations, ranging from plain radiographs to ultrasound, computed tomography and magnetic resonance imaging, may help achieve a precise diagnosis. […] Clinical evaluation still plays a pivotal role in TOS diagnosis, combining a proper history and physical examination with provocative tests. However, the diagnosis of TOS is often a diagnosis of exclusion, and its confirmation can be challenging, lacking specificity. Imaging studies and electrodiagnostic tests may complete the diagnostic work-up, confirming neurovascular compression and disclosing the location and extent of the compression. […] This review offers a broad up-to-date overview of clinical presentation, diagnostic and therapeutic (non-surgical and surgical) approaches to TOS.

• #1 Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5872004/

  The diagnosis of thoracic outlet syndrome (TOS) has long been a controversial and challenging one. […] Depending on the subdivision of TOS suspected, diagnostic investigations are currently of varying importance, necessitating high dependence on good history taking and clinical examination. […] In this article, we set out to summarise the diagnostic approach in cases of suspected TOS, including the importance of history taking, clinical examination, and the role of investigations at present, and highlight the developments in this field with respect to all subtypes. […] The difficulty and lack of clarity on the subject of TOS has been acknowledged by the Society for Vascular Surgery from the point of view of both diagnostic criteria and a lack of evidence-based treatment after findings from a Cochrane Collaboration review.

• #1 How to truly identify and treat thoracic outlet syndrome (TOS) – MSK Neurology

  https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/

  The infamous thoracic outlet syndrome. TOS is considered to be one of modern medicines most difficult issues, because of the complex and variable nature of its symptoms. […] Despite more than 2600 references to TOS on pubmed, there is still wide controversy regarding TOS; no concrete diagnostic criteria have been established, and many practitioners claim that the whole problem is a fad which does not really exist. […] This review was complicated by a lack of generally accepted diagnostic criteria for the diagnosis of TOS. Thoracic outlet syndrome is one of the most controversial diagnoses in clinical medicine. […] The diagnosis of neurogenic TOS is more challenging because its symptoms of nerve compression are not unique. […] Conversely, no valid standard diagnostic test is available for disputed neurogenic TOS, resulting in controversies in the frequency of TOS diagnosis.

• #1 Neurogenic and Nonspecific-type thoracic outlet syndrome – Diagnosis and treatment –

  https://caringmedical.com/prolotherapy-news/really-thoracic-outlet-syndrome-treatment/

  „Those who diagnose and treat patients with thoracic outlet syndrome, especially those patients with neurogenic thoracic outlet syndrome, have a practice, which needs to include many modalities to diagnose, treat, and intervene to improve their quality of life for the present and for the future. Three key points constitute the mainstay of the art of caring for thoracic outlet patients. Initially, the most important thing is to make an accurate diagnosis. The second most important thing is not to offer interventions that will not help, perhaps harm, and to give false hope to those who have complex symptoms and have had interventions elsewhere without success. The third thing is to develop an algorithm of consistent evaluation and treatment for each patient to ensure an optimal outcome.” […] Over the years we have seen many people with the diagnosis of thoracic outlet syndrome. In so many of these people, after we performed a detailed physical examination, we found that they did not have thoracic outlet syndrome at all.

• #1 Thoracic Outlet Syndrome Care | Ochsner Health

  https://www.ochsner.org/services/thoracic-outlet-syndrome-center/

  Thoracic outlet syndrome (TOS) is not a common condition. Less than 2% of the population is diagnosed with some form of thoracic outlet syndrome. […] It takes great expertise to determine whether a patient is suffering from TOS or something else. The symptoms often overlap with rotator cuff injuries, cervical disc disorders, cervical dystonia, fibromyalgia, multiple sclerosis, tumors of the spinal cord and other conditions. […] The diagnosis of NTOS is challenging and may require many different evaluations and tests to rule out other conditions that can cause similar symptoms. […] Diagnosis of thoracic outlet syndrome is complex and varies depending on the symptoms and form of TOS that is suspected. A thorough history and physical examination is critical to initially suspect the diagnosis. To verify or rule out TOS, your team may recommend diagnostic imaging such as X-ray, CT, MRI or ultrasound. Other tests such as EMG/nerve conduction studies, angiograms and/or nerve blocks may also be necessary.

• #1 Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5872004/

  Increasingly it is being realised that MRI can be used not only to evaluate the anatomy of the thoracic outlet, in particular soft tissue structures that might be causing compression, but also to visualise actual compression of the brachial plexus directly. […] This technique suppresses signal from surrounding soft tissue structures, including fat containing structures, and removes pulsation artefacts from flowing blood. […] The hope is that by quantifying these parameters, diagnostically significant improvements in symptoms and function post-block can be more objectively assessed. […] As we can see, diagnosis of TOS is complicated by the variety of presentations, the number of differential diagnoses, including co-existence of diagnoses such as arterial with NTOS and peripheral compressive neuropathies with TOS, and the variable reliability of provocative manoeuvres and investigations when used in isolation.

• #1 Thoracic Outlet Syndrome (TOS) Causes, Symptoms, Treatments

  https://www.upmc.com/services/heart-vascular/conditions/thoracic-outlet-syndrome

  At UPMC, we take a team approach to quickly and correctly diagnosing TOS. […] In most cases, your doctor can diagnose TOS during a physical exam. You may need other tests to confirm the diagnosis. […] To confirm a diagnosis of TOS, your doctor will start by: Asking about your TOS symptoms. Asking you to perform movements to reproduce the symptoms. Performing a thorough exam. Reviewing your medical history. […] Your doctor may order heart imaging and other tests, including: Arteriography or venography. Chest x-ray. Computed tomography (CT) scan. Magnetic resonance imaging (MRI). Nerve conduction velocity test. Ultrasound. […] Early diagnosis and treatment of TOS are key to reducing the risk of complications and delivering a successful treatment outcome. Your prognosis will depend on the type of TOS you have, as well as the severity of your condition.

• #1 Diagnostics | Special Issue : Diagnosis and Treatment of Thoracic Outlet Syndrome

  https://www.mdpi.com/journal/diagnostics/special_issues/TOS

  Diagnosis of TOS and appropriate patient selection for intervention are challenging due to the frequent presence of vague symptoms in neurogenic TOS. […] The primary goals of this Special Issue on “Diagnosis and Treatment of Thoracic Outlet Syndrome” are to describe new and established diagnostic and treatment modalities for TOS; to discuss approaches to complex clinical situations, such as reoperative treatment; and to review new research developments in the field of TOS.

• #2 Diagnostic and Therapeutic Approach to Thoracic Outlet Syndrome

  https://www.mdpi.com/2379-139X/10/9/103

  Thoracic outlet syndrome (TOS) is a group of symptoms caused by the compression of neurovascular structures of the superior thoracic outlet. The knowledge of its clinical presentation with specific symptoms, as well as proper imaging examinations, ranging from plain radiographs to ultrasound, computed tomography and magnetic resonance imaging, may help achieve a precise diagnosis. […] Clinical evaluation still plays a pivotal role in TOS diagnosis, combining a proper history and physical examination with provocative tests. However, the diagnosis of TOS is often a diagnosis of exclusion, and its confirmation can be challenging, lacking specificity. Imaging studies and electrodiagnostic tests may complete the diagnostic work-up, confirming neurovascular compression and disclosing the location and extent of the compression. […] This review offers a broad up-to-date overview of clinical presentation, diagnostic and therapeutic (non-surgical and surgical) approaches to TOS.

• #2 Thoracic outlet syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/592

  Thoracic outlet syndrome (TOS) refers to an uncommon but potentially disabling group of conditions characterized by symptoms that result from compression of neurovascular structures crossing through the anatomic space of the thoracic outlet. […] The main types of TOS include neurogenic, venous, and arterial. Patients may present with signs and symptoms of nerve, vein, or artery compression, or a combination of these. […] Neurogenic TOS primarily develops in people in their late teens up to the age of 60 years and is more common in women. […] Initial management is usually conservative and includes physical therapy. […] Venous TOS refers to symptoms caused by compression of the axillary-subclavian vein at the thoracic outlet, principally in the costoclavicular space. […] The most common symptoms include the spontaneous onset of substantial arm swelling, cyanotic discoloration, aching discomfort, and enlargement of the superficial subcutaneous veins in the shoulder, upper chest, and arm.

• #2 Diagnosing Thoracic Outlet Syndrome | NYU Langone Health

  https://nyulangone.org/conditions/thoracic-outlet-syndrome/diagnosis

  The thoracic outlet is the space between the collarbone and the first rib. […] NYU Langone doctors from the Thoracic Outlet Syndrome Program are experts at providing an accurate diagnosis for this relatively rare condition. […] Your NYU Langone doctor takes a medical history to learn about your symptoms and then performs a physical exam to check for swelling, distended veins, unusual skin color, or cold hands. […] Your doctor may also order one or more imaging tests to diagnose thoracic outlet syndrome. […] This body maneuvering test can help identify the type of thoracic outlet syndrome you have. […] A chest X-ray creates pictures of the body to help identify any abnormalities in the bones, including an extra, or cervical, rib or an unusually small thoracic outlet. […] Your doctor may use this test to assess blood flow in the arteries in the thoracic outlet. This helps the doctor to identify any blockages or compression.

• #2 Thoracic outlet syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/592

  Arterial TOS refers to symptoms arising from longstanding compression and damage to the subclavian artery, usually in the setting of a bony abnormality (e.g., cervical rib). […] Key diagnostic factors include history of repetitive jobs or overhead hobbies/activities, pain in upper extremity and adjacent areas, paresthesias in arms, hands, and/or fingers, circulatory changes in upper extremity, and upper extremity fatigue. […] Other diagnostic factors include history of clavicular fracture, palpation of cervical rib, subcutaneous venous collateral distention around shoulders (Urschel sign), motor weakness, hyperhidrosis, thenar eminence muscle atrophy, exertional pain/claudication, supraclavicular systolic bruit, blood pressure difference between extremities, and positive Adson (scalene) test. […] Diagnostic tests include CXR, cervical spine x-ray, electrodiagnostic testing (nerve conduction velocity and electromyography), duplex ultrasonography, contrast venography, catheter-directed therapy, and CT angiography.

• #2 Thoracic Outlet Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/thoracic-outlet-syndrome/

  Thoracic outlet syndrome (TOS) refers to a constellation of upper extremity symptoms from compression of neurovascular structures coursing through the thoracic inlet. […] Accurate diagnosis and incidence of TOS is difficult due to the absence of consistently reproducible objective measures. […] It is important to evaluate for mimics of TOS in diagnostic phase. Differential diagnosis includes C8-T1 radiculopathy, brachial plexopathy, carpal tunnel syndrome, ulnar neuropathy, intrinsic shoulder pathology, cubital tunnel syndrome, quadrilateral space syndrome and myofascial pain. […] The current provocative special tests used to diagnose TOS have low specificity and thus, high false positive rates. […] Studies indicate that utilizing multiple tests in conjunction may increase the specificity of TOS identification.

• #2 Diagnosing Neurogenic Thoracic Outlet Syndrome – How Reliable Are Current Testing Methods? | Department of Surgery | Washington University in St. Louis

  https://surgery.wustl.edu/diagnosing-neurogenic-thoracic-outlet-syndrome-how-reliable-are-current-testing-methods/

  Pain, numbness, tingling, swelling, weakness and impaired circulation can be signs of a number of different conditions and health issues, but the root of the problem can be difficult to pin down. […] Thoracic outlet syndrome (TOS) is a group of conditions that often evade diagnosis. […] NTOS diagnosis often involves a long process of ruling out these conditions first. […] One physical examination maneuver often used to identify NTOS is the elevated arm stress test (EAST). […] While the conventional EAST can assist in the diagnosis of NTOS and exclusion of other conditions, its accuracy and value in doing so reliably is debated. […] They found a positive predictive value of 65%-66% and a negative predictive value of 53%-58%, highlighting the limitations of the conventional EAST as a single diagnostic test for NTOS.

• #2 The diagnosis of thoracic outlet syndrome | JVD

  https://www.dovepress.com/the-diagnosis-of-thoracic-outlet-syndrome-peer-reviewed-fulltext-article-JVD

  The use of electromyography and nerve conduction studies in diagnosing TOS is controversial. […] X-ray of the cervical spine and chest are the first imaging investigations for TOS. […] The decision to investigate further will depend upon the presentation, history, and clinical findings. […] DSA has been regarded as the gold standard investigation for arterial abnormalities. […] Modern cross-sectional imaging techniques are very effective in demonstrating vascular pathologies such as impingement or obstruction and have the advantage of being much less invasive. […] MRI is increasingly used in the diagnosis of vascular TOS. […] There is still controversy over the use of MRI for neurogenic TOS. […] Appropriate investigations need to be tailored to the individual and there is no single diagnostic test. […] Clinical history and examination dictates the need for electrophysiological testing and subsequent imaging.

• #2 Thoracic Outlet Syndrome Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/96412-workup

  CT scanning and MRI are more useful for identifying other conditions that might cause similar symptoms, rather than for establishing the diagnosis of thoracic outlet syndrome. […] MRA can be useful for the diagnosis of arterial vascular thoracic outlet syndrome. […] Venography and duplex scanning (ie, ultrasonography combined with Doppler velocity waveforms) are used to assist in the diagnosis of subclavian vein compression (thrombosis). […] Electrodiagnostic studies can be helpful for classic cases of neurogenic thoracic outlet syndrome and therefore can be useful when the results are positive. […] Nerve conduction velocity has been used for the diagnosis of thoracic outlet syndrome as defined by a reduction to less than 85 m/s of either the ulnar or median nerves across the thoracic outlet and was found to corroborate the clinical diagnosis.

• #2 Diagnosing Thoracic Outlet Syndrome | NYU Langone Health

  https://nyulangone.org/conditions/thoracic-outlet-syndrome/diagnosis

  Your NYU Langone doctor may order this test even if a chest X-ray indicates there are no problems with the thoracic outlet. […] An MRI scan uses a magnetic field and radio waves to create computerized, 2D and 3D images of the body. It helps doctors determine if any chest veins and arteries are blocked or compressed. […] In this test, a contrast dye is injected into the arteries or veins, enabling your doctor to clearly see any blockages.

• #2 Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5872004/

  Increasingly it is being realised that MRI can be used not only to evaluate the anatomy of the thoracic outlet, in particular soft tissue structures that might be causing compression, but also to visualise actual compression of the brachial plexus directly. […] This technique suppresses signal from surrounding soft tissue structures, including fat containing structures, and removes pulsation artefacts from flowing blood. […] The hope is that by quantifying these parameters, diagnostically significant improvements in symptoms and function post-block can be more objectively assessed. […] As we can see, diagnosis of TOS is complicated by the variety of presentations, the number of differential diagnoses, including co-existence of diagnoses such as arterial with NTOS and peripheral compressive neuropathies with TOS, and the variable reliability of provocative manoeuvres and investigations when used in isolation.

• #2 Diagnosis of thoracic outlet syndrome with the lower trunk compression of brachial plexus by high-frequency ultrasonography | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06762-7

  An alternative is high-frequency ultrasonography (HFUS), a valuable technology that has long been applied for the assessment of superficial organs, tissues, and blood vessels, and it has also been applied recently to assess nerves. […] The aim of the present retrospective study was to summarize the ultrasound characteristics of TOS with the lower trunk compression of brachial plexus to provide references for TOS diagnosis. […] HFUS plays an important role in the dynamic diagnosis of TOS and provides valuable information for clinical strategies. […] On the basis of the surgical results, we found that the main etiological factor of TOS was muscle hypertrophy and/or fibrosis, with hypertrophy and/or fibrosis of the anterior or middle scalene muscle accounting for 79.3% of cases. […] HFUS is valuable for TOS diagnosis because it reflects both the morphology and the location of brachial plexus lesions and can detect muscular or bony factors causing nerve compression, providing important information for clinical treatment and postoperative follow-up.

• #2 Thoracic Outlet Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/thoracic-outlet-syndrome/

  Electrodiagnostic testing may be helpful to distinguish nTOS from aTOS and vTOS. However, EDX has low specificity and high false positive rates. EDX can be normal for patients with nTOS. EDX can also rule out other neurologic causes. […] MRI/MRA with provocative arm positions is the optimal imaging test for evaluation of TOS. […] A major gap in evidence-based knowledge is the absence of an objective grading system for TOS upon which consensus for diagnosis and indications for treatment can be made.

• #2 How to truly identify and treat thoracic outlet syndrome (TOS) – MSK Neurology

  https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/

  With regards to diagnosis of N-TOS, it has been shown that EMG, NCV and MR neurographies are not reliable diagnostic criteria. […] Findings showed denervation activity, increased mean action potential amplitude, and/or duration and reduced recruitment at maximum effort. However, there is still some question as to whether EMG is adequately sensitive to detect changes in NTOS patients with milder symptoms. […] Somatosensory evoked potentials (SEPs) are used in the diagnosis of thoracic outlet syndrome (TOS), even as an indication for surgery. […] The interscalene triangle is usually the main entrapment point (culprit), and will often stand for 60-80% of the patients symptoms. […] To evaluate the scalenes involvement, the therapist pushes the thumb into the brachial plexus, in the middle of the distal anterior and middle scalene fibers.

• #2 Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5872004/

  Once a diagnosis of TOS is suspected on clinical grounds, it is important to characterise the anatomy of the thoracic outlet, particularly with respect to potential sources of compression, as this can guide management approaches, especially if surgery is to be considered. […] In diagnosing VTOS, duplex ultrasound is typically employed if thrombosis is suspected, with very high sensitivity and specificity of 78-100% and 82-100%, respectively. […] NTOS is a field where the contribution of diagnostic investigations is certainly changing. […] Another testing modality suggested by the Society for Vascular Surgery is to inject the scalene and pectoralis minor muscles with local anaesthetic to check for alleviation of symptoms, the rationale being that the scalene triangle and pectoralis minor space are common sites of compression.

• #2 Thoracic Outlet Syndrome > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/thoracic-outlet-syndrome

  How is thoracic outlet syndrome diagnosed? To diagnose TOS, your doctor will review your medical history, perform a physical exam, and run one or more diagnostic tests. […] Additional tests are necessary to confirm the diagnosis. These may include: Imaging tests such as a chest and spine X-ray, magnetic resonance imaging (MRI) scan, magnetic resonance angiography (MRA), computed tomography (CT) scan, or ultrasound. […] Electromyography (EMG) measures the electrical activity of a muscle. […] Nerve conduction studies measure the speed at which nerves conduct electrical impulses. […] Anterior scalene and pectoralis minor muscle block, a test in which a local anesthetic is injected into the anterior scalene muscle (a muscle in the neck that connects to your spinal nerves) and/or the pectoralis minor (a muscle in your upper chest). If the injection relieves symptoms, it lets doctors know that the injected muscle is the site of the compression of nerves or blood vessels.

• #2 Thoracic Outlet Syndrome Treatment – Scripps Health

  https://www.scripps.org/services/vascular-disease-care/thoracic-outlet-syndrome

  Scripps Health in San Diego provides expert diagnosis and treatment for an uncommon group of disorders known as thoracic outlet syndrome (TOS). Because TOS cant be effectively treated without a precise diagnosis, its important to seek care from physicians who not only have experience identifying the various forms of the disorder, but can prescribe the right combination of medical treatment and vascular surgery. […] The most important first step in treating TOS is getting a proper diagnosis by vascular surgeons who are familiar with the disorders and can properly distinguish TOS from other medical conditions that cause similar symptoms. […] Scripps physicians can diagnose thoracic outlet syndrome using one or more of the following tests: […] Scalene muscle blocks are often used to determine whether a person has TOS and, if so, whether they would respond well to surgery. During the procedure, an anesthetic is injected into the scalene muscle, which connects to the first rib. When the muscle relaxes, allowing the first rib to drop, it opens up the space within the thoracic outlet. If the patients symptoms improve once the anesthetic has taken effect (meaning the nerves and blood vessels are no longer compressed), the person is likely to be diagnosed with TOS.

• #2 Thoracic Outlet Syndrome Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/96412-workup

  In thoracic outlet syndrome with vascular compromise or nerve compression, with resultant atrophy of the intrinsic hand muscles, the diagnosis is not controversial and specific tests can confirm the diagnosis. Jednakże, no infallible clinical tests, laboratory tests, radiographic tests, or electrical studies establish the diagnosis of thoracic outlet syndrome syndrome in patients with disputed or nonspecific-type thoracic outlet syndrome. […] Many tests are available to refine the differential diagnosis and confirm or exclude other potential conditions. […] To exclude systemic disease and inflammation, a few simple blood tests may refine the differential diagnosis for thoracic outlet syndrome, including a blood glucose level, complete blood cell (CBC) count, erythrocyte sedimentation rate (ESR), basic metabolic panel, thyrotropin level, and rheumatologic workup, if indicated.

• #2 Thoracic outlet syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Thoracic_outlet_syndrome

  Thoracic outlet syndrome is somewhat difficult to diagnose since there is no set diagnostic criteria. Doctors may use medical imaging, nerve conduction studies, or a variety of tests designed to trigger symptoms. […] The diagnosis may be supported by nerve conduction studies and medical imaging. […] MRI scan can show the anatomy of the thoracic outlet, the soft tissues causing compression, and can show directly the brachial plexus compression.

• #2 Diagnosis of Neurogenic Thoracic Outlet Syndrome: 2016 Consensus Guidelines and Other Strategies | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-55073-8_9

  The diagnosis of neurogenic thoracic outlet syndrome (TOS) depends upon clinical suspicion, pattern-recognition, and exclusion of more common conditions that have overlapping features. […] In most patients a diagnosis of neurogenic TOS can be made or excluded on the basis of the clinical history, description of symptoms, and physical examination. […] The clinical diagnosis may then be supported, clarified, or challenged by a limited number of adjunctive diagnostic studies. […] Application of these diagnostic criteria in a prospective, observational, cohort study is illustrated. […] Broader use of these diagnostic criteria will be a valuable step toward achieving more consistent clinical care and improved comparative effectiveness research for neurogenic TOS.

• #2 Thoracic Outlet Syndrome Care | Ochsner Health

  https://www.ochsner.org/services/thoracic-outlet-syndrome-center/

  Thoracic outlet syndrome (TOS) is not a common condition. Less than 2% of the population is diagnosed with some form of thoracic outlet syndrome. […] It takes great expertise to determine whether a patient is suffering from TOS or something else. The symptoms often overlap with rotator cuff injuries, cervical disc disorders, cervical dystonia, fibromyalgia, multiple sclerosis, tumors of the spinal cord and other conditions. […] The diagnosis of NTOS is challenging and may require many different evaluations and tests to rule out other conditions that can cause similar symptoms. […] Diagnosis of thoracic outlet syndrome is complex and varies depending on the symptoms and form of TOS that is suspected. A thorough history and physical examination is critical to initially suspect the diagnosis. To verify or rule out TOS, your team may recommend diagnostic imaging such as X-ray, CT, MRI or ultrasound. Other tests such as EMG/nerve conduction studies, angiograms and/or nerve blocks may also be necessary.

• #2 Thoracic Outlet Syndrome Diagnosis | Temple Health

  https://www.templehealth.org/services/conditions/thoracic-outlet-syndrome/diagnosis

  Diagnosing thoracic outlet syndrome can be difficult because the symptoms and their severity can vary greatly from person to person. […] To confirm a diagnosis, your doctor will review your medical history, perform a physical exam and review the results of specific tests that are used to diagnose thoracic outlet syndrome. […] TOS can be difficult for non-specialists to diagnose. But our multidisciplinary team has extensive experience in diagnosing thoracic outlet syndrome correctly and can offer advanced treatment options.

• #2 Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5872004/

  The diagnosis of thoracic outlet syndrome (TOS) has long been a controversial and challenging one. […] Depending on the subdivision of TOS suspected, diagnostic investigations are currently of varying importance, necessitating high dependence on good history taking and clinical examination. […] In this article, we set out to summarise the diagnostic approach in cases of suspected TOS, including the importance of history taking, clinical examination, and the role of investigations at present, and highlight the developments in this field with respect to all subtypes. […] The difficulty and lack of clarity on the subject of TOS has been acknowledged by the Society for Vascular Surgery from the point of view of both diagnostic criteria and a lack of evidence-based treatment after findings from a Cochrane Collaboration review.

• #2 How to truly identify and treat thoracic outlet syndrome (TOS) – MSK Neurology

  https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/

  Diagnosis and treatment of thoracic outlet syndrome (TOS) involves neurologists, physiatrists, family physicians, orthopedic surgeons, vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists. […] Thoracic outlet syndrome (TOS) is controversial in terms of definition, anatomy, aetiology and treatment. […] Taking the research above into account, the reader can probably start to understand that its often very difficult to be properly diagnosed and treated if one has thoracic outlet syndrome. […] Provocative pressure testing is a very reliable way of diagnosing thoracic outlet syndrome, because it shows the therapist exactly where the nerves are irritated. […] The tinels sign has been shown to have poor specificity in the literature, but because plexopathic problems are so controversial, there is not reason to rely on this.

• #2 Diagnosis of Neurogenic Thoracic Outlet Syndrome is critical

  https://www.tosmri.com/diagnosis-of-neurogenic-thoracic-outlet-syndrome/

  The accurate and timely diagnosis of neurogenic thoracic outlet syndrome (TOS) is critically important in determining the outcome of the disease. […] The diagnosis of neurogenic TOS often has a more insidious and intermittent presentation. Thus, the accurate and early diagnosis of neurogenic thoracic outlet syndrome may be elusive. However, accurate diagnosis and early treatment are important in shortening the course of the disease and in preventing permanent pain or motor function loss. […] The clinical diagnosis of neurogenic thoracic outlet syndrome challenges physicians. Patients with neurogenic thoracic outlet syndrome experience a broad range of symptoms that appear confusing to many doctors. […] An experienced TOS specialist focuses the clinical diagnosis of neurogenic thoracic outlet syndrome on two important components: an accurate and detailed medical history and a specialized physical examination.

• #2 Thoracic Outlet Syndrome Diagnosis In Kuala Lumpur

  https://www.chiropractic-in-malaysia.com/blog/thoracic-outlet-syndrome-diagnosis

  Thoracic outlet syndrome diagnosis is the most critical step in resolving neurovascular compression symptoms affecting the neck, shoulders, arms, and hands. TOS can closely mimic conditions such as cervical disc disorders, rotator cuff injuries, brachial plexopathy, carpal tunnel syndrome (CTS DIagnosis), and even cardiac or vascular disease. […] Accurate diagnosis ensures that care is targeted and appropriate, avoiding mismanagement that could worsen symptoms. […] Early and accurate diagnosis is essential to initiate the right care and avoid long-term complications. […] Diagnosing thoracic outlet syndrome (TOS) requires ruling out a wide range of conditions with overlapping symptoms. […] According to research published in the Journal of Hand Surgery (Ferrante & Ferrante, 2010), nearly 40% of TOS diagnoses are initially misclassified due to similarities with other nerve compression disorders.

• #3 Thoracic Outlet Syndrome (TOS): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17553-thoracic-outlet-syndrome-tos

  Thoracic outlet syndrome (TOS) occurs when theres compression of nerves or blood vessels in your lower neck and upper chest. […] The wide range of symptoms, which could point to many possible problems, can challenge and delay diagnosis. […] Healthcare providers diagnose TOS by performing a physical exam and reviewing your medical history. […] Providers order lab and imaging tests as needed to confirm TOS and rule out other causes of your symptoms. […] You may need one or more of the following tests: Blood tests. Chest X-ray. Computed tomography (CT) of the chest and/or spine. Electromyography (EMG). Magnetic resonance angiography (MRA) of your blood vessels. Magnetic resonance imaging (MRI) of the chest and/or spine. Nerve conduction study. […] These tests help your provider: Look for anatomical variants (like a cervical rib). Evaluate blood flow through your arteries and veins. Rule out other conditions that cause similar symptoms. Check the function of your muscles and nerves. Find the exact location of compression.

• #3 Thoracic outlet syndrome: a hard problem in diagnosis and management – Povlsen – Shanghai Chest

  https://shc.amegroups.org/article/view/4036/html

  Thoracic outlet syndrome presents a diagnostic and management challenge to general practitioners, physicians and surgeons alike. […] As Vos et al. (1) have identified, part of the challenge in the management of TOS is the lack of recognised diagnostic criteria (2). Clinicians must use a combination of accurate history taking, clinical examination and the use of other diagnostic tools where appropriate. Each subtype of TOS, venous, arterial and neurogenic, presents differently. […] By far the most common category of TOS, but unfortunately also by far the greatest challenge diagnostically, is that of neurogenic TOS whereby compression of the brachial plexus is theorised to cause upper extremity pain. This form represents 9095% of cases of TOS (3). […] Unfortunately there are no accepted clinical diagnostic criteria in NTOS and as such the responsibility lies with the individual clinicians judgement.

• #3 Thoracic Outlet Syndrome – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/thoracic-outlet-syndrome/

  Often, there is not a clear and obvious way to diagnose thoracic outlet syndrome. In some cases, your doctor will perform many tests to rule out other conditions with similar symptoms, such as pinched nerves in your neck or blood clots. […] In some health care institutions, thoracic outlet syndrome is diagnosed and treated by a multidisciplinary team that includes an orthopaedic surgeon, a physical medicine and rehabilitation specialist (PMR specialist, or physiatrist), physical therapists, a peripheral nerve surgeon, and/or a vascular surgeon.

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