J Korean Med Assoc.  2017 Dec;60(12):963-970. 10.5124/jkma.2017.60.12.963.

Thoracic outlet syndrome

• Kwon YH
• Chung H

• KMID: 2397865
• DOI: http://doi.org/10.5124/jkma.2017.60.12.963

Abstract

Thoracic outlet syndrome (TOS) is an uncommon condition that can occur when the nerves, artery, or vein to the arm is compressed by one or more of the structures that make up the thoracic outlet. TOS was the first compression neuropathy of the upper extremity to be identified. The wide variability of patients' symptoms, which include vascular and neural signs, as well as diffuse symptoms, and the lack of a valid and reliable test to confirm the diagnosis of TOS makes it difficult to identify correctly patients with TOS. Rates of three to 80 cases per 1,000 patients have been reported, but more patients are likely to have TOS because it is underestimated. Additionally, the primary controversy regarding patients with TOS is related to symptoms such as paresthesia, numbness, and pain. No positive objective test exists to confirm an accurate diagnosis. If patients present with diffuse pain and numbness in the neck and upper extremity with more than 2 provocation tests, TOS could be considered. The purpose of this review is to provide an overview of the causes, classification, evaluation, and management of TOS.

Keyword

Thoracic outlet syndrome; Nerve compression syndromes; Upper extremity

MeSH Terms

Arm
Arteries
Classification
Diagnosis
Humans
Hypesthesia
Neck
Nerve Compression Syndromes
Paresthesia
Thoracic Outlet Syndrome*
Upper Extremity
Veins

Figure

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  Figure 1 Anatomy of thoracic outlet. The subclavian artery, vein, and brachial plexus are passing through the anterior scalene muscle. Reproduced from Korean Orthopaedic Association. Orthopaedics. 7th ed. Seoul: Korean Orthopaedic Association; 2013, with permission from Young-Ho Kwon [16].

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  Figure 2 Hyperabduction test. Shoulder abducted above 90° and arm hyperabducted to 180° leads to diminishing radial pulse. Neurovascular structures compressed in subcoracoid region by pectoralis minor tendon, head of humerus or coracoid process. Reproduced from Korean Orthopaedic Association. Orthopaedics. 7th ed. Seoul: Korean Orthopaedic Association; 2013, with permission from Young-Ho Kwon [16].

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  Figure 3 Neck tilt test. Neck rotation with arms at the side eliciting neck and arm pain, discomfort and paresthesia down the contralateral side. Reproduced from Korean Orthopaedic Association. Orthopaedics. 7th ed. Seoul: Korean Orthopaedic Association; 2013, with permission from Young-Ho Kwon [16].

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  Figure 4 Costoclavicular compression test. Shoulder retracted and depressed leads to diminish radial pulse and/or arm pain and paresthesia. Reproduced from Korean Orthopaedic Association. Orthopaedics. 7th ed. Seoul: Korean Orthopaedic Association; 2013, with permission from Young-Ho Kwon [16].

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