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Thoracic outlet syndrome

Última revisão: 23 Sep 2025
Última atualização: 15 Nov 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • 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
  • upper extremity fatigue
Detalhes completos

Outros fatores diagnósticos

  • 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
  • positive Adson (scalene) test
  • positive costoclavicular test
  • positive hyperabduction test
  • positive elevated arm stress test (Roos test)
  • positive stretch test
  • positive upper limb tension tests
  • positive Wright maneuver
  • edema/swelling of upper extremity
Detalhes completos

Fatores de risco

  • cervical ribs (partial or complete)
  • abnormal (hypoplastic) first rib or bony abnormalities
  • anomalies of muscular development (interdigitation, scalene minimis muscle)
  • fibro-fascial or ligamentous bands
  • fractures of clavicle or first rib
  • overdevelopment of muscles (bodybuilding, heavy labor with upper extremities)
  • traumatic injuries (whiplash, upper extremity distraction injuries)
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • CXR
  • cervical spine x-ray
  • electrodiagnostic testing (nerve conduction velocity and electromyography)
  • duplex ultrasonography
  • contrast venography, catheter-directed therapy
  • CT angiography
Detalhes completos

Investigações a serem consideradas

  • MRI neck/clavicle/shoulder
  • muscle block
  • conventional arteriography
  • magnetic resonance angiography (MRA)
  • magnetic resonance venography (MRV)
  • CBC, coagulation, and thrombophilia studies
Detalhes completos

Algoritmo de tratamento

AGUDA

neurogenic TOS (NTOS)

venous TOS (vTOS)

arterial TOS (ATOS)

neurovascular (combined)

Colaboradores

Autores

Robert W. Thompson, MD

Center for Thoracic Outlet Syndrome

Department of Surgery (Section of Vascular Surgery)

Washington University School of Medicine and Barnes-Jewish Hospital

St. Louis

MO

Declarações

RWT is an author of several references cited in this topic, has coauthored articles with other authors on this topic, has contributed to educational events on this topic, has provided expert witness testimony on this topic, and has directed use of philanthropic funds received by Washington University School of Medicine to support staff for research on this topic.

Hugh A. Gelabert, MD

Division of Vascular Surgery

Gonda (Goldschmied) Vascular Center

David Geffen School of Medicine at UCLA

Los Angeles

CA

Declarações

HAG is an author of several references cited in this topic, has coauthored articles with other authors on this topic, has contributed to educational events on this topic, has provided expert witness testimony on this topic, and has directed use of philanthropic funds received by University of California Los Angeles School of Medicine to support research on this topic.

Joep A. W. Teijin​k, MD

​Department of Vascular Surgery

Catharina Hospital

Eindhoven

The Netherlands

Department of Epidemiology

CAPHRI School for Public Health and Primary Care

Faculty of Health, Medicine and Life Sciences

Maastricht University

Maastricht

The Netherlands

Declarações

JAWT is coauthor of several references cited in this topic, has contributed to educational events on this topic, and has provided expert witness testimony on this topic. No financial disclosures.

Agradecimentos

Dr Robert W. Thompson, Dr Joep A.W. Teijink, and Dr Hugh A. Gelaber would like to gratefully acknowledge Dr Chaney Stewman, Dr Marc I. Harwood, Dr Pedro K. Beredjiklian, Dr Peter C. Vitanzo, Dr Harold C. Urschel Jr, Rachel Montano, and Brenda Knee, previous contributors to this topic. CS is the author of a reference cited in this topic. MIH is the author of a reference cited in this topic. PKB has stock ownership in Wright Medical Inc. PCV is the author of a reference cited in this topic. HCU is an author of several references cited in this topic. RM and BK declare that they have no competing interests.

Revisores

Ian Loftus, BSc, MB, ChB, FRCS, MD

Professor of Vascular Surgery

St. George's NHS Healthcare Trust

London

UK

Declarações

IL declares that he has no competing interests.

Scott R. Laker, MD

Assistant Professor

University of Colorado School of Medicine

Aurora

CO

Declarações

SRL is the author of a reference cited in this topic.

John A. Kern, MD

Chief

Cardiothoracic Surgery

University of Virginia School of Medicine

Charlottesville

VA

Declarações

JAK declares that he has no competing interests.

Créditos aos pareceristas

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Referências

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Principais artigos

Illig KA, Donahue D, Duncan A, et al. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. J Vasc Surg. 2016 Sep;64(3):e23-35.Texto completo  Resumo

Vemuri C, McLaughlin LN, Abuirqeba AA, et al. Clinical presentation and management of arterial thoracic outlet syndrome. J Vasc Surg. 2017 May;65(5):1429-39.Texto completo  Resumo

Vemuri C, Salehi P, Benarroch-Gampel J, et al. Diagnosis and treatment of effort-induced thrombosis of the axillary subclavian vein due to venous thoracic outlet syndrome. J Vasc Surg Venous Lymphat Disord. 2016 Oct;4(4):485-500.Texto completo  Resumo

George EL, Arya S, Rothenberg KA, et al. Contemporary practices and complications of surgery for thoracic outlet syndrome in the United States. Ann Vasc Surg. 2021 Apr;72:147-58. Resumo

Peek J, Vos CG, Ünlü Ç, et al. Outcome of surgical treatment for thoracic outlet syndrome: systematic review and meta-analysis. Ann Vasc Surg. 2017 Apr;40:303-26. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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    • Thoracic outlet syndrome part I: systematic review of the literature and consensus on anatomy, diagnosis, and classification of thoracic outlet syndrome by the European Association of Neurosurgical Societies’ section of peripheral nerve surgery
    • Thoracic outlet syndrome part II: consensus on the management of neurogenic thoracic outlet syndrome by the European Association of Neurosurgical Societies' section of peripheral nerve surgery
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