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Thoracic Outlet Syndrome: A Review

Sanders, Richard J. MD*; Hammond, Sharon L. MD; Rao, Neal M. MD

doi: 10.1097/NRL.0b013e318176b98d
Review Article

Background: Arterial and venous thoracic outlet syndrome (TOS) were recognized in the late 1800s and neurogenic TOS in the early 1900s. Diagnosis and treatment of the 2 vascular forms of TOS are generally accepted in all medical circles. On the other hand, neurogenic TOS is more difficult to diagnose because there is no standard objective test to confirm clinical impressions.

Review Summary: The clinical features of arterial, venous, and neurogenic TOS are described. Because neurogenic TOS is by far the most common type, the pathology, pathophysiology, diagnostic tests, differential and associate diagnoses, and treatment are detailed and discussed. The controversial area of objective and subjective diagnostic criteria is addressed.

Conclusion: Arterial and venous TOS are usually not difficult to recognize and the diagnosis can be confirmed by angiography. The diagnosis of neurogenic TOS is more challenging because its symptoms of nerve compression are not unique. The clinical diagnosis relies on documenting several positive findings on physical examination. To date there is still no reliable objective test to confirm the diagnosis, but measurements of the medial antebrachial cutaneous nerve appear promising.

From the *Department Surgery, Rose Medical Center; Departments of †Surgery, and ‡Medicine, University of Colorado Health Science Center, Denver, Colorado.

Reprints: Dr. Richard J. Sanders, MD, 4545 E. Ninth Avenue, #240, Denver, Colorado, 80220. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.