შეჯამება
განსაზღვრება
History and exam
Key diagnostic factors
- 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
Other diagnostic factors
- 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
Risk factors
- 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)
Diagnostic investigations
1st investigations to order
- CXR
- cervical spine x-ray
- electrodiagnostic testing (nerve conduction velocity and electromyography)
- duplex ultrasonography
- contrast venography, catheter-directed therapy
- CT angiography
Investigations to consider
- MRI neck/clavicle/shoulder
- muscle block
- conventional arteriography
- magnetic resonance angiography (MRA)
- magnetic resonance venography (MRV)
- CBC, coagulation, and thrombophilia studies
Treatment algorithm
neurogenic TOS (NTOS)
venous TOS (vTOS)
arterial TOS (ATOS)
neurovascular (combined)
Contributors
Authors
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
Disclosures
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
Disclosures
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. Teijink, 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
გაფრთხილება:
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.
მადლიერება
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.
რეცენზენტები
Ian Loftus, BSc, MB, ChB, FRCS, MD
Professor of Vascular Surgery
St. George's NHS Healthcare Trust
London
UK
გაფრთხილება:
IL declares that he has no competing interests.
Scott R. Laker, MD
Assistant Professor
University of Colorado School of Medicine
Aurora
CO
გაფრთხილება:
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
გაფრთხილება:
JAK declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
წყაროები
ძირითადი სტატიები
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.სრული ტექსტი აბსტრაქტი
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.სრული ტექსტი აბსტრაქტი
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.სრული ტექსტი აბსტრაქტი
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. აბსტრაქტი
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. აბსტრაქტი
გამოყენებული სტატიები
ამ თემაში მოხსენიებული წყაროების სრული სია ხელმისაწვდომია მომხმარებლებისთვის, რომლებსაც აქვთ წვდომა BMJ Best Practice-ის ყველა ნაწილზე.
დიფერენციული დიაგნოზები
- Vasospasm, embolism, or insufficiency
- Coronary artery disease
- Myocardial infarction
მეტი დიფერენციული დიაგნოზებიგაიდლაინები
- 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
მეტი გაიდლაინებიპაციენტის ბროშურები
Raynaud phenomenon
მეტი პაციენტის ბროშურებიშედით სისტემაში ან გამოიწერეთ BMJ Best Practice
ამ მასალის გამოყენება ექვემდებარება ჩვენს განცხადებას