special tests for thoracic outlet syndrome

Previous articles published in peer-reviewed journals, as well as references cited in relevant articles, were also systematically reviewed. A comprehensive electronic literature search, including PubMed, MEDLINE, and Google Scholar databases (1950–2021), was conducted. This review aims to provide physicians a brief summary of both pathogenesis, diagnosis, and treatment of TOS, as well as significant findings in the recent literature. While many TOS treatment options exist, the optimal therapy regimen remains unclear. Surgery is usually indicated in symptomatic nTOS candidates who have failed 4–6 weeks of conservative therapy, as well as the vascular etiologies of TOS. Injection therapy has also been shown to be temporarily effective in reducing symptomatic TOS, as well as a positive surgical prognostic factor.

While physical therapy is typically the mainstay in conservative nTOS management, other aspects of nTOS treatment may include lifestyle modification, pain management, and anticoagulation. Treatment of TOS is a multifactorial process, and therapeutic options vary depending on the presenting subtype. Diagnosis depends upon both knowledge of the patient’s existing risk factors as well as their clinical presentation and may be confirmed with physical exam maneuvers, radiographic imaging, or vascular studies. TOS can be caused by congenital, acquired, or traumatic factors, although some degree of trauma is usually seen in a majority of TOS cases. TOS is usually subclassified into neurogenic TOS (nTOS), venous TOS (vTOS), and arterial TOS (aTOS), depending on the appropriate etiology upon presentation. Structures involved in TOS include the subclavian artery and vein, the axillary artery and vein, and brachial plexus-any or all of which may be compressed, resulting in distinct clinical pictures, which can include pain, paresthesia, pallor, weakness, feelings of fullness, and muscle atrophy. TOS classically occurs in three spaces-the scalene triangle, the costoclavicular space, and the subcoracoid space.

Thoracic outlet syndrome (TOS) comprises a group of disorders that result in compression of the neurovasculature exiting the thoracic outlet and was first described in 1956.

Special tests for thoracic outlet syndrome