Best Practice Case Studies-Thoracic Outlet Syndrome

Pdf Summary

The review on Thoracic Outlet Syndrome (TOS) explores this collection of disorders resulting from neurovascular compression as structures exit the thoracic outlet, affecting the brachial plexus and subclavian vessels. TOS manifests primarily as pain, paresthesia, pallor, and weakness, contingent on the structures involved. Classifications include neurogenic TOS (nTOS), venous TOS (vTOS), and arterial TOS (aTOS). The review emphasizes the lack of consensus in diagnostic criteria, necessitating thorough patient history, physical examinations, and imaging for accurate diagnosis.<br /><br />Epidemiologically, TOS is more prevalent in adolescents to middle-aged adults, particularly females aged 20-50. Neurogenic TOS accounts for 95% of cases, while vTOS and aTOS are less common. Etiologies range from congenital, acquired, to traumatic causes, with neck trauma being a major factor.<br /><br />Regarding anatomy, TOS involves three crucial spaces: the scalene triangle, costoclavicular space, and subcoracoid space, each containing various crucial neurovascular elements.<br /><br />Clinical presentation varies with the type – nTOS primarily affecting the brachial plexus, vTOS usually associated with upper limb swelling and venous issues, and aTOS characterized by ischemia and pain. Diagnosis incorporates history, physical exam, and imaging techniques such as radiography, CT, and MRI.<br /><br />Conservative treatment is foremost, involving physical therapy, activity modification, and pharmacotherapy; surgical intervention is considered for cases unresponsive to conservative management or those with severe vascular symptoms. Botulinum toxin injections may provide temporary relief for muscular compression in nTOS. Surgical options like rib resection and scalenectomy are viable for refractory cases, proving effective in many patients.<br /><br />Despite varied treatment approaches, optimal therapeutic regimens remain uncertain, underscoring the need for consensus and standardized diagnostic and management protocols to improve patient outcomes in TOS cases.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 38

Topic Neurology

Keywords

3rd Edition, CASE 38

3rd Edition

Neurology

Thoracic Outlet Syndrome

neurovascular compression

brachial plexus

subclavian vessels

neurogenic TOS

venous TOS

arterial TOS

diagnostic criteria

conservative treatment

surgical intervention