Thoracic Outlet Syndrome: A Narrative Review

Overview

Journal J Clin Med

Specialty General Medicine

Date 2021 Apr 3

PMID 33804565

Citations 18

Authors

Nathan Li

Gregor Dierks

Hayley E Vervaeke

Allison Jumonville

Alan D Kaye

Dariusz Myrcik

Antonella Paladini

Giustino Varrassi

Omar Viswanath

Ivan Urits

Affiliations

Soon will be listed here.

Abstract

Thoracic outlet syndrome comprises a group of disorders that result in compression of the brachial plexus and subclavian vessels exiting the thoracic outlet. Symptoms include pain, paresthesia, pallor, and weakness depending upon the compromised structures. While consensus in diagnostic criteria has not yet been established, a thorough patient history, physical exam, and appropriate imaging studies are helpful in diagnosis. General first-line therapy for thoracic outlet syndrome is a conservative treatment, and may include physical therapy, lifestyle modifications, NSAIDs, and injection therapy of botulinum toxin A or steroids. Patients who have failed conservative therapy are considered for surgical decompression. This article aims to review the epidemiology, etiology, relevant anatomy, clinical presentations, diagnosis, and management of thoracic outlet syndrome.

Citing Articles

Intractable pain due to thoracic outlet syndrome successfully treated with percutaneous epidural adhesiolysis: A case report.

Ishida Y, Kobayashi R, Hara E, Takaoka H, Shintaku M, Taketomi A SAGE Open Med Case Rep. 2024; 12:2050313X241299956.

PMID: 39569399 PMC: 11577454. DOI: 10.1177/2050313X241299956.

Arterial Thoracic Outlet Syndrome-A Case Study of a 23-Year-Old Female Patient Diagnosed Using a Thermal Imaging Camera.

Zolnierczuk M, Skolozdrzy T, Donotek M, Szlosser Z, Prowans P, Krol M Healthcare (Basel). 2024; 12(17).

PMID: 39273749 PMC: 11394808. DOI: 10.3390/healthcare12171725.

Paraspinal Muscle Morphology in Proximal Cervical Spondylotic Amyotrophy.

Hirota R, Takashima H, Emori M, Takebayashi T, Teramoto A Cureus. 2024; 16(7):e64255.

PMID: 39130928 PMC: 11315232. DOI: 10.7759/cureus.64255.

An Uncommon Culprit: Trapezius Dystonia as a Cause of Thoracic Outlet Syndrome: A Case Report.

Philp J, Jeong W, Paily P Cureus. 2024; 16(7):e63825.

PMID: 39099970 PMC: 11297692. DOI: 10.7759/cureus.63825.

Current Clinical Concepts: Rehabilitation of Thoracic Outlet Syndrome.

Hock G, Johnson A, Barber P, Papa C J Athl Train. 2024; 59(7):683-695.

PMID: 39048118 PMC: 11277273. DOI: 10.4085/1062-6050-0138.22.

References

Franklin G, Fulton-Kehoe D, Bradley C, Smith-Weller T . Outcome of surgery for thoracic outlet syndrome in Washington state workers' compensation. Neurology. 2000; 54(6):1252-7. DOI: 10.1212/wnl.54.6.1252. View

Novak C, Mackinnon S, Patterson G . Evaluation of patients with thoracic outlet syndrome. J Hand Surg Am. 1993; 18(2):292-9. DOI: 10.1016/0363-5023(93)90364-9. View

Hwang J, Min B, Jo W, Shin J . Video-assisted thoracoscopic surgery for intrathoracic first rib resection in thoracic outlet syndrome. J Thorac Dis. 2017; 9(7):2022-2028. PMC: 5542955. DOI: 10.21037/jtd.2017.06.122. View

Mackinnon S, Novak C . Clinical commentary: pathogenesis of cumulative trauma disorder. J Hand Surg Am. 1994; 19(5):873-83. DOI: 10.1016/0363-5023(94)90205-4. View

Walsh M . Therapist management of thoracic outlet syndrome. J Hand Ther. 1994; 7(2):131-44. DOI: 10.1016/s0894-1130(12)80083-4. View

Povlsen S, Povlsen B . Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions. Diagnostics (Basel). 2018; 8(1). PMC: 5872004. DOI: 10.3390/diagnostics8010021. View

Blank R, CONNAR R . Arterial complications associated with thoracic outlet compression syndrome. Ann Thorac Surg. 1974; 17(4):315-24. DOI: 10.1016/s0003-4975(10)65657-3. View

Jordan S, Ahn S, Gelabert H . Combining ultrasonography and electromyography for botulinum chemodenervation treatment of thoracic outlet syndrome: comparison with fluoroscopy and electromyography guidance. Pain Physician. 2007; 10(4):541-6. View

Wybaillie E, Maene L, Cooreman F, Beelen R . Robotically Assisted Transthoracic Cervical Rib Resection. Ann Thorac Surg. 2018; 106(5):e253-e255. DOI: 10.1016/j.athoracsur.2018.04.016. View

10.

Danielson K, Odderson I . Botulinum toxin type A improves blood flow in vascular thoracic outlet syndrome. Am J Phys Med Rehabil. 2008; 87(11):956-9. DOI: 10.1097/PHM.0b013e31818a51c3. View

11.

Torriani M, Gupta R, Donahue D . Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using a ultrasound-guided approach. Skeletal Radiol. 2010; 39(10):973-80. DOI: 10.1007/s00256-010-0897-1. View

12.

Latremoliere A, Woolf C . Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009; 10(9):895-926. PMC: 2750819. DOI: 10.1016/j.jpain.2009.06.012. View

13.

Illig K, Donahue D, Duncan A, Freischlag J, Gelabert H, Johansen K . Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome: Executive summary. J Vasc Surg. 2016; 64(3):797-802. DOI: 10.1016/j.jvs.2016.05.047. View

14.

Hussain M, Aljabri B, Al-Omran M . Vascular Thoracic Outlet Syndrome. Semin Thorac Cardiovasc Surg. 2016; 28(1):151-7. DOI: 10.1053/j.semtcvs.2015.10.008. View

15.

Cheng S, Reilly L, Nelken N, Ellis W, Stoney R . Neurogenic thoracic outlet decompression: rationale for sparing the first rib. Cardiovasc Surg. 1995; 3(6):617-23; discussion: 624. DOI: 10.1016/0967-2109(96)82859-6. View

16.

Revel M, Amor B . [Rehabilitation of cervico-thoraco-brachial outlet syndromes]. Phlebologie. 1983; 36(2):157-65. View

17.

Ferrante M, Ferrante N . The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome. Muscle Nerve. 2016; 55(6):782-793. DOI: 10.1002/mus.25536. View

18.

Pupovac S, Lee P, Zeltsman D, Jurado J, Hyman K, Singh V . Robotic-Assisted First Rib Resection: Our Experience and Review of the Literature. Semin Thorac Cardiovasc Surg. 2020; 32(4):1115-1120. DOI: 10.1053/j.semtcvs.2020.04.016. View

19.

Sucher B, Heath D . Thoracic outlet syndrome--a myofascial variant: Part 3. Structural and postural considerations. J Am Osteopath Assoc. 1993; 93(3):334, 340-5. View

20.

Povlsen B, Hansson T, Povlsen S . Treatment for thoracic outlet syndrome. Cochrane Database Syst Rev. 2014; (11):CD007218. PMC: 11245746. DOI: 10.1002/14651858.CD007218.pub3. View