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  • Updated 07.20.2020
  • Released 11.09.2005
  • Expires For CME 07.20.2023

Thoracic outlet syndrome

Introduction

Overview

The thoracic outlet syndromes are a heterogeneous group of distinct disorders that share a common feature: the compression of neurovascular structures in the thoracic outlet. Subtypes of thoracic outlet syndromes include true neurogenic, disputed, arterial, venous, and traumatic neurovascular. They can be characterized by their respective clinical manifestations, etiologies, electrodiagnostic and imaging features, and managements.

Key points

• The thoracic outlet syndromes include true neurogenic, disputed, arterial, venous, and traumatic neurovascular subtypes.

• True neurogenic thoracic outlet syndrome is extremely rare. The syndrome can result from an anomalous fibrous band stretching from an abnormally elongated C7 transverse process or a cervical rib, to the first thoracic rib, impinging on the lower trunk of the brachial plexus or T1 spinal root.

• Sensory symptoms over the medial hand or forearm and intrinsic hand muscle weakness and atrophy, disproportionately involving the thenar eminence, are typical symptoms and signs of true neurogenic thoracic outlet syndrome.

• Disputed thoracic outlet syndrome is best considered a cervicoscapular pain syndrome.

Historical note and terminology

The term thoracic outlet syndrome is a misnomer as there are several forms of this syndrome, and the term thoracic outlet syndromes should be used instead. This nosology has resulted in controversy and debate over diagnosis and treatment.

The first notion of thoracic outlet syndrome may have occurred in the 2nd century AD with the mention of a cervical rib by Galen (18). Over time, greater recognition of both vascular and neurologic types of thoracic outlet syndromes developed slowly until the early 1900s, when detailed clinical studies were presented. In 1910, Murphy performed the first rib resection and reported improvement (18). The term "thoracic outlet syndrome" was coined by Peet in 1956, although his definition encompassed all the forms and causes of neurovascular compression at the neck (16).

Terms used in the past for thoracic outlet syndrome have included cervical rib and band syndrome, scalenus anticus syndrome, costoclavicular syndrome, pectoralis minor syndrome, and hyperabduction syndrome, among others (04; 05).

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