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
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
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)
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
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
Algoritmo de tratamento
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. 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
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
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
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.
Diagnósticos diferenciais
- Vasospasm, embolism, or insufficiency
- Coronary artery disease
- Myocardial infarction
Mais Diagnósticos diferenciaisDiretrizes
- 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
Mais DiretrizesFolhetos informativos para os pacientes
Raynaud phenomenon
Mais Folhetos informativos para os pacientesConectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal