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Children (Basel) 2022 Jun 12;9(6). Epub 2022 Jun 12.

Department of Pediatric Neurology, Oregon Health & Science University, Portland, OR 97239, USA.

Thoracic outlet syndrome (TOS) is a condition that results from the compression of neurovascular structures as they exit the thorax. Arterial ischemic stroke can occur in TOS due to retrograde embolism from the subclavian artery. We describe a 15-year-old girl who presented with left hemiplegia after 2 weeks of right arm numbness and tingling. Read More

Ann Med Surg (Lond) 2022 Jun 28;78:103819. Epub 2022 May 28.

Bolan Medical College Quetta, Pakistan.

Ischemic monomelic neuropathy (IMN) is an infrequently recognized type of ischemic neuropathy produced by the shunting of blood away from, or the acute non compressive occlusion of, a major proximal limb artery. IMN consists of multiple mononeuropathies with axonal-loss that develop acutely and simultaneously in the distal portion of a limb. Ischemic neuropathies in a single limb are well-known following compression (casts or tourniquet use), proximal vascular procedures like AV fistula formation, thoracic outlet syndrome, trauma, and thromboembolism. Read More

Child Neurol Open 2022 Jan-Dec;9:2329048X221105743. Epub 2022 Jun 7.

Division of Pediatric Neurology, Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.

Arterial thoracic outlet syndrome is a rare condition characterized by compression of the subclavian artery, often with post-stenotic aneurysm formation. Artery-to-artery embolic strokes related to thoracic outlet syndrome have been reported in the posterior circulation and in the ipsilateral anterior circulation. We present a case in which a thrombus secondary to thoracic outlet syndrome caused a contralateral anterior circulation stroke in an adolescent and postulate mechanisms of this rare occurrence. Read More

Clin Imaging 2022 Jun 8;89:23-36. Epub 2022 Jun 8.

Mallinckrodt Institute of Radiology at Washington University School of Medicine, St. Louis, MO, United States of America. Electronic address:

Thoracic outlet syndrome (TOS) is a clinical disorder resulting from compression of the neurovascular bundle of the lower neck and upper chest. TOS can be categorized into neurogenic, venous, and arterial subtypes which result from anatomical compression of the brachial plexus, subclavian vein, and subclavian artery, respectively. This can lead to neurogenic pain as well as vascular injury with thrombosis and thromboembolism. Read More

J Can Chiropr Assoc 2022 Apr;66(1):43-60

Division of Research and Innovation, Canadian Memorial Chiropractic College.

Exercise rehabilitation has been proposed for the management of Neurogenic Thoracic Outlet Syndrome (NTOS). To date there have been no reviews of the literature regarding exercise rehabilitation for NTOS and their proposed clinical rationale. Understanding various exercise protocols and their clinical rationale may help guide rehabilitation clinicians in their exercise selection when managing NTOS. Read More

Ultrasonography 2022 Feb 23. Epub 2022 Feb 23.

Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy.

Vascular compression syndromes include a group of rare changes due to extrinsic compression of veins or arteries by surrounding structures. These pathologies are often underestimated due to their rarity, clinicians' poor level of knowledge, and the non-specificity of their symptoms. The best known are Eagle syndrome, thoracic outlet syndrome, nutcracker syndrome, May-Thurner syndrome, Dunbar syndrome, and popliteal entrapment syndrome. Read More

Cureus 2022 Apr 24;14(4):e24437. Epub 2022 Apr 24.

Internal Medicine, Lahey Hospital and Medical Center, Burlington, USA.

Paget-Schroetter syndrome, also known as venous thoracic outlet syndrome, is primarily an effort-induced thrombosis of the subclavian and axillary veins. Treatment modalities involve systemic anticoagulation, catheter-directed thrombolysis (CDT), and surgical decompression. Early endovascular intervention is noted to improve outcomes and result in symptomatic relief. Read More

Rozhl Chir 2022 ;101(4):176-179

Introduction: First rib resection is a standard surgical treatment for decompressing the neurovascular structures in thoracic outlet syndrome (TOS). Historically, open approaches were used. In this report, we present technical details of thoracoscopic first rib resection. Read More

J Vasc Surg Cases Innov Tech 2022 Jun 11;8(2):287-292. Epub 2022 Apr 11.

Center for Thoracic Outlet Syndrome, Department of Surgery, Washington University School of Medicine, St Louis, MO.

Supraclavicular operations can be associated with postoperative cutaneous dysesthesia and hypersensitivity. Regenerative peripheral nerve interfaces, created by attaching the proximal end of a divided peripheral nerve into a viable muscle target, can promote neurite regrowth and neuromuscular connections to help suppress painful nerve hyperactivity. During 40 consecutive operations for neurogenic thoracic outlet syndrome, we demonstrated that division of at least one of the superficial supraclavicular cutaneous sensory nerve branches was necessary in 98% of cases. Read More

PLoS One 2022 25;17(5):e0268842. Epub 2022 May 25.

Dept. of Neurology, Semmelweis University, Budapest, Hungary.

We investigated the diagnostic utility of combined nerve and vascular ultrasound in thoracic outlet syndrome (TOS) in a retrospective cohort study on two sites, involving 167 consecutive patients with the clinical symptoms suggestive of neurogenic and/or vascular TOS, and an age- and sex-matched control group. All patients and control subjects underwent nerve ultrasound of the supraclavicular brachial plexus to look for fibromuscular anomalies / compression of the brachial plexus in the scalenic region, and vascular ultrasound of the infraclavicular subclavian artery with the arm in neutral and abducted position, serving as an indicator for costoclavicular compression of the neurovascular bundle. Based on clinical symptoms, neurogenic TOS (81%) was the most frequent type of TOS, followed by combined neurogenic and arterial TOS (8%). Read More

J Thromb Haemost 2022 May 24. Epub 2022 May 24.

Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Objectives: Primary deep vein thrombosis of the upper extremity (UEDVT) is a rare condition but up to 60% of patients may develop post-thrombotic syndrome in the upper extremity (UE-PTS) with significant morbidity and decreased quality of life. However, there is no universally accepted method to diagnose and classify UE-PTS, hampering scientific research on UEDVT treatment. Through this international Delphi consensus study we aimed to determine what a clinical score for diagnosing UE-PTS should entail. Read More

Clin Case Rep 2022 May 15;10(5):e05842. Epub 2022 May 15.

Internal Medicine Department Centro Hospitalar Tâmega e Sousa Penafiel Portugal.

Thoracic outlet syndrome results from neurovascular compression at the thoracic outlet. Clinical presentation varies according to the predominantly compressed structure, determining its subtype: neurogenic, venous, or arterial. The neurogenic subtype is the most common, affecting 90% of patients, while the vascular subtype is rarely found in practice. Read More

Orthop Traumatol Surg Res 2022 May 18:103329. Epub 2022 May 18.

Unité de chirurgie de la main et du membre supérieur, services d'orthopédie 1 et 2, CHRU de Tours, 37044 Tours, France. Electronic address:

Introduction: Neurogenic thoracic outlet syndromes (TOS) are dominated by the nonspecific forms. This study focuses only on the rarer true forms related to proximal nerve compression in the thoracic outlet, with the presence of motor (atrophy of the hand's intrinsic muscles) and/or sensory (hypoesthesia in the territory of the medial antebrachial cutaneous nerve) deficits. The objectives of this study were to define the clinical characteristics, anatomical causes and surgical results of this condition. Read More

J Vasc Surg 2022 May 10. Epub 2022 May 10.

Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. Electronic address:

Objectives: We developed a standardized elevated arm stress test (EAST)-meter to standardize posture and measure additional grip and fatigue parameters. This study aims to determine the reliability and validity of the standardized EAST (sEAST) in the diagnosis of neurogenic thoracic outlet syndrome (NTOS).

Design: Prospective cohort study METHODS: Patients evaluated for NTOS between October 2018 and February 2020 were included and performed the sEAST. Read More

J Vasc Surg 2022 May 10. Epub 2022 May 10.

Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands. Electronic address:

Objectives: The objective of this retrospective analysis of prospectively collected data was to assess the test-retest reliability and validity of the elevated arm stress test (EAST) as measured by the duration in a cohort of patients with suspected neurogenic thoracic outlet syndrome (NTOS).

Methods: Patients evaluated for NTOS between January 2017 and September 2018 were identified. Test-retest reliability by the intraclass correlation coefficient was determined for duration of the EAST. Read More

Eur J Vasc Endovasc Surg 2022 May 7. Epub 2022 May 7.

Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands; CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands. Electronic address:

Objectives: Neurogenic Thoracic Outlet Syndrome (NTOS) is one of the most controversial clinical entities in medicine. Several major case series have shown promising results of surgery, however solid scientific evidence is lacking. The aim of this trial was to objectify the effect of thoracic outlet decompression (TOD). Read More

Vascular 2022 May 4:17085381221088416. Epub 2022 May 4.

Department of Surgery, 1261St. Joseph Mercy Hospital, Ann Arbor, MI, USA.

Objectives: Recurrent effort thrombosis after prior surgical intervention for venous thoracic outlet syndrome (TOS) is an uncommon problem, and there are multiple alternative surgical approaches in the management of recurrent venous TOS.

Methods: We present a case of a 23 year-old female professional athlete who presented with arm swelling, pain, and recurrent effort thrombosis after prior transaxillary rib resection. Imaging at our institution revealed subclavian vein thrombosis, confirmed with dynamic venography, as well as a remnant first rib. Read More

Orthop J Sports Med 2022 Apr 21;10(4):23259671221079835. Epub 2022 Apr 21.

Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

Background: Thoracic outlet syndrome (TOS) is a rare injury that affects Major League Baseball (MLB) pitchers and is often corrected with surgical resection of the first rib. There are limited return-to-play (RTP) data for this surgery in MLB pitchers.

Hypothesis: It was hypothesized that MLB pitchers who undergo first rib resection for TOS will show (1) a high rate of RTP, (2) no difference in postoperative career length compared with controls, (3) no difference in pre- and postoperative performance, and (4) no difference in postoperative performance compared with controls. Read More

Vasc Endovascular Surg 2022 Apr 30:15385744221091437. Epub 2022 Apr 30.

Division of Vascular and Endovascular Surgery, 12279Wake Forest Baptist Health, Winston-Salem, NC, USA.

Thoracic Outlet Syndrome (TOS) is a rare condition caused by compression of the neurovascular structures of the thoracic outlet. Patients with TOS are found to have a greater prevalence of supernumerary or abnormal first ribs compared to the general population. Symptoms can sometimes be incited by a neck injury, especially in patients with abnormal cervical anatomy. Read More

Reumatol Clin (Engl Ed) 2022 04;18(4):249-250

Department of Physical and Rehabilitation Medicine, UZ Leuven, Leuven, Belgium; Department of Development and Regeneration, University Leuven, Leuven, Belgium.

Clin Case Rep 2022 Apr 22;10(4):e05514. Epub 2022 Apr 22.

Department of Internal Medicine Hamad Medical Corporation Doha Qatar.

Cervical ribs are rare and usually asymptomatic. Occasionally, they can cause nerve impingements and compressive symptoms. In cervical ribs, osteomyelitis secondary to trauma is unheard of. Read More

Muscle Nerve 2022 Jul 24;66(1):6-14. Epub 2022 Apr 24.

H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.

Musculoskeletal mimics of cervical radiculopathy will be explored in this AANEM monograph. A review of the literature and textbooks was conducted. Musculoskeletal cervical radiculopathy mimics include: (1) head/neck pain, such as neck tension, cervicogenic headache, and temporomandibular disorder; (2) referred pain from shoulder pathology, such as rotator cuff tears/impingement; (3) elbow region abnormalities, including medial/lateral epicondylitis; (4) wrist/hand conditions, such as DeQuervain's tenosynovitis and intersection syndrome; (5) muscle connective tissue disorders, including myofascial trigger points; (6) conditions that have decreased range of motion, including frozen shoulder and rounded shoulders with tight pectoral/scalene muscles; (7) conditions with joint hyperlaxity and instability, as seen in post-stroke shoulder subluxation; (8) vascular conditions, such as thoracic outlet syndrome; and (9) autonomic controlled soft tissue changes associated with complex regional pain syndrome. Read More

Ann Vasc Surg 2022 Apr 22. Epub 2022 Apr 22.

Division of Vascular and Endovascular Surgery, University of Texas Health at San Antonio, San Antonio, TX; Department of Surgery, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX. Electronic address:

Background: The internet has become a leading resource for patients, to research information about their medical conditions. Access to inaccurate information can lead to miscommunication, poor patient satisfaction and effect shared decision-making with the provider. This study seeks to evaluate the quality and readability of patient resources that appear in the top search results for Thoracic Outlet Syndrome (TOS). Read More

JBJS Case Connect 2022 04 1;12(2). Epub 2022 Apr 1.

Int J Crit Illn Inj Sci 2022 Jan-Mar;12(1):54-57. Epub 2022 Mar 24.

Department of Surgical Intensive Care, Surgical Intensive Care Unit, Rashid Hospital, Oud Metha, Dubai, United Arab Emirates.

Paget-Schroetter syndrome (PSS), which is also called "effort thrombosis," is a venous variant of thoracic outlet syndrome. We report a rare case of upper-limb deep venous thrombosis (ULDVT) in a young patient who was later diagnosed as PSS. PSS is a rare cause of ULDVT, and it is usually seen in young adults who are involved in strenuous physical activity. Read More

PM R 2022 Apr 10. Epub 2022 Apr 10.

Emory University School of Medicine, Atlanta, Georgia, USA.

Thoracic outlet syndrome is an important cause of shoulder pain and dysfunction due to compression of neurovascular structures as they traverse the thoracic outlet. Symptoms are most commonly due to compression of the brachial plexus called neurogenic thoracic outlet syndrome (nTOS). Throwing athletes are at increased risk of nTOS because of a variety of biomechanical factors. Read More

Front Cardiovasc Med 2022 22;9:802183. Epub 2022 Mar 22.

Department of Internal Medicine, General Medicine Unit, Thrombotic and Haemorrhagic Disorders Unit, University Hospital of Padua, Padua, Italy.

The Thoracic Outlet Syndrome is a clinical potentially disabling condition characterized by a group of upper extremity signs and symptoms due to the compression of the neurovascular bundle passing through the thoracic outlet region. Because of the non-specific nature of signs and symptoms, to the lack of a consensus for the objective diagnosis, and to the wide range of etiologies, the actual figure is still a matter of debate among experts. We aimed to summarize the current evidence about the pathophysiology, the diagnosis and the treatment of the thoracic outlet syndrome, and to report a retrospective analysis on 324 patients followed for 5 years at the Padua University Hospital and at the Naples Fatebenefratelli Hospital in Italy, to verify the effectiveness of a specific rehabilitation program for the syndrome and to evaluate if physical therapy could relieve symptoms in these patients. Read More

JBJS Case Connect 2022 04 6;12(2). Epub 2022 Apr 6.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Case: A 43-year-old woman presented with pain, paresthesia, and coldness of the right upper extremity suggestive of the diagnosis of thoracic outlet syndrome. Three-dimensional computed tomography angiography revealed that the right subclavian artery was constricted because it traveled over an abnormal first rib. After anticoagulation and antithrombotic therapy, the patient underwent resection of the abnormal first rib. Read More

J Vasc Surg 2022 Apr 1. Epub 2022 Apr 1.

Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.

Objective: Arterial thoracic outlet syndrome (ATOS) is rare. We present our 30-year experience with the management of ATOS at a high-volume referral center.

Methods: A retrospective review of all patients who had undergone primary operative treatment for ATOS from 1988 to 2018 was performed. Read More

J Vasc Surg 2022 Mar 31. Epub 2022 Mar 31.

Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. Electronic address:

Objectives: Surgery for neurogenic thoracic outlet syndrome (NTOS) has shown good outcome in numerous case series. However, 5% to 30% of patients will have persistent or recurrent symptoms, caused by incomplete first rib resection, reattachment of residual scalene muscle, fibrous scarring around the brachial plexus, or a wrong NTOS diagnosis. In patients with a sound diagnosis of recurrent or persisting NTOS, not responding to conservative measures, a secondary procedure can be considered. Read More