Abstract
The objective of this paper is to discuss the classification, diagnosis, pathophysiology and management of Thoracic outlet syndrome (TOS). Thoracic outlet syndrome (TOS) is a complex entity that is characterized by different neurovascular signs and symptoms involving the upper limb. TOS is defined as upper extremity symptoms due to compression of the neurovascular bundle in the area of the neck just above the first rib. Compression is thought to occur at one or more of the three anatomical compartments: the interscalene triangle, the costoclavicular space and the retropectoralis minor spaces. The clinical presentation can include both neurogenic and vascular symptoms. TOS can be difficult to diagnose because there is no standardized objective test that can be used and the clinician must rely on history and several positive findings on physical exam. The medial antebrachial cutaneous nerve conduction may be a sensitive way to detect pathology in the lower trunks of the brachial plexus which is promising for future research. Treatment options continue to be conservative and surgical. However, for those who have failed physical therapy there is research to suggest that botulinum toxin may help with symptom relief. However, given that there has been conflicting evidence, further research is required using randomized controlled trials.
Highlights
Thoracic outlet syndrome (TOS) is a complex entity that is characterized by different neurovascular signs and symptoms involving the upper limb
It can be difficult to diagnose because there is no standardized objective test that can be used and the clinician must rely on history and several positive findings on physical exam
New research suggests that medial antebrachial cutaneous nerve conduction is a sensitive way to detect pathology in the lower trunks of the brachial plexus which is promising for future research
Summary
Thoracic outlet syndrome (TOS) is a complex entity that is characterized by different neurovascular signs and symptoms involving the upper limb. A definition of TOS is “upper extremity symptoms due to compression of the neurovascular bundle in the area of the neck just above the first rib” [1]. Over the past decade there has been increasing interest in the role of botulinum toxin (BTX) in the management of musculoskeletal conditions including TOS. The aim of this paper is to provide a review of the classification, diagnosis, pathophysiology and current management of TOS. It will discuss the potential use of BTX in the treatment of TOS. The goals are to stimulate further discussion regarding the role of BTX in the treatment of TOS and to suggest areas of future study
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