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Thoracic outlet syndrome

ბოლო მიმოხილვა: 20 Aug 2025
ბოლო განახლება: 15 Nov 2024

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
Full details

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
Full details

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)
Full details

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
Full details

Investigations to consider

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

Treatment algorithm

ACUTE

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. 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

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

ჩვენი მტკიცებულებებისა და სარედაქციო ჯგუფები თანამშრომლობენ საერთაშორისო ექსპერტებსა და რეცენზენტებთან, რათა უზრუნველვყოთ თქვენი წვდომა კლინიკურად ყველაზე მნიშვნელოვან ინფორმაციაზე.

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.
  • Thoracic outlet syndrome images
  • დიფერენციული დიაგნოზები

    • Vasospasm, embolism, or insufficiency
    • Coronary artery disease
    • Myocardial infarction
    მეტი დიფერენციული დიაგნოზები
  • გაიდლაინები

    • 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 გაიდლაინები
  • პაციენტის ბროშურები

    Raynaud phenomenon

    მეტი პაციენტის ბროშურები
  • padlock-lockedშედით სისტემაში ან გამოიწერეთ BMJ Best Practice

ამ მასალის გამოყენება ექვემდებარება ჩვენს განცხადებას