Abstract
Neurogenic thoracic outlet syndrome is a widely recognized, yet controversial, syndrome. The lack of specific objective diagnostic modalities makes diagnosis difficult. This is compounded by a lack of agreed upon definitive criteria to confirm diagnosis. Recent efforts have been made to more clearly define a set of diagnostic criteria that will bring consistency to the diagnosis of neurogenic thoracic syndrome. Additionally, advancements have been made in the quality and techniques of various imaging modalities that may aid in providing more accurate diagnoses. Surgical decompression remains the mainstay of operative treatment; and minimally invasive techniques are currently in development to further minimize the risks of this procedure. Medical management continues to be refined to provide non-operative treatment modalities for certain patients, as well. The aim of the present work is to review these updates in the diagnosis and treatment of neurogenic thoracic outlet syndrome.
Highlights
Neurogenic Thoracic Outlet Syndrome is a clinical diagnosis that describes the symptomatic manifestation of the compression of the neurologic structures traversing the thoracic outlet, namely the brachial plexus
Diagnostics 2017, 7, 28 criteria for Neurogenic Thoracic Outlet Syndrome (nTOS). This group consists of physicians and scientists from multiple disciplines working together with the intention of assisting practitioners in accurately identifying, and employing appropriate management strategies for, those patients presenting with symptoms suggestive of nTOS
One vascular surgery referral center determined only 1/3 of the 621 patients referred for surgical intervention were appropriate candidates for First Rib Resection with Scalenectomy (FRRS). This institution demonstrated a 91% surgical success rate in those who were offered operative management [20]. This institute selects patients with nTOS who are refractory to an eight-week course of physical therapy and responsive to anterior scalene muscle blocks with Botox or lidocaine for surgical intervention [1]
Summary
Neurogenic Thoracic Outlet Syndrome (nTOS) is a clinical diagnosis that describes the symptomatic manifestation of the compression of the neurologic structures traversing the thoracic outlet, namely the brachial plexus. It is the most common of the three subtypes of TOS representing 95%. There were no clear guidelines to define which patients clearly demonstrate a clinical diagnosis of nTOS. New developments in objective diagnostic studies, as well as more clearly-defined guidelines for proper diagnosis of nTOS help to better identify patients suffering from nTOS so that these patients may receive appropriate treatment. New surgical approaches, including video-assisted thoracoscopic, endoscopic-assisted and robotic approaches demonstrate excellent outcomes
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