THORACIC OUTLET SYNDROME

Abstract

Background: Thoracic outlet syndrome (TOS) is a clinical entity characterized by compression of the neurovascular bundle of the upper limb as it passes from the upper thoracic aperture to the axilla. Although thrombosis of the axillosubclavian vein was first reported by Paget in 1875 and Von Schroetter in 1884, and was coined “Paget-Schroetter syndrome” by Hughes in 1949, the term “Thoracic Outlet Syndrome” was coined in the 1950s to reflect the fact that TOS has many variants, ranging from vascular involvement of the subclavian artery (SCA) or vein (SCV) to the more common neurogenic form with compression of the brachial plexus . Aim of work: Is to review the historical background, surgical anatomy, aetiology, clinical picture, investigations, differential diagnosis and treatment of the thoracic outlet syndrome. Methodology: Patients with severe vascular compression and brachial plexus compression with intrinsic muscle atrophy likely will require surgical intervention. However, in the patients with brachial plexus nerve compression and no muscle atrophy, operation should be recommended only for the few patients whose symptoms are not relieved with an appropriate program of physical therapy that addresses posture, neural mobility, and cervicoscapular muscle imbalance. Conclusion: Thoracic outlet syndrome results from mechanical compression of various structures of the thoracic outlet. It remains controversial in both diagnosis and treatment, particularly in patients with brachial plexus nerve compression and no muscle atrophy. The diagnosis of TOS is a clinical diagnosis based on reproduction of patient symptoms with provocation testing (arm elevation) and exclusion of other conditions that can cause similar symptoms.