From the Guidelines
Thoracic outlet syndrome (TOS) has an estimated prevalence of approximately 10 per 100,000 people, as reported in the most recent study 1. The exact prevalence of TOS is unknown, but symptomatic TOS has been estimated to be around this figure. This condition is likely underdiagnosed due to its variable symptoms and the challenges in establishing a definitive diagnosis.
- TOS can affect anyone, but it is more common in individuals who perform activities that require repetitive upper-extremity movement, such as swimming or throwing.
- Anatomical variants, such as a cervical rib, can also cause narrowing of the scalene triangle and lead to symptoms of TOS.
- The condition can result in neurological symptoms, including chronic arm and hand paresthesia, numbness, or weakness, as well as venous and arterial symptoms.
- Early recognition and proper diagnosis are crucial to prevent long-term nerve and vascular complications, and consultation with a radiologist may be useful in optimizing the study for the prevailing clinical symptom 1.
- The current management of TOS is variable, and understanding the various anatomic spaces, causes of narrowing, and resulting neurovascular changes are important in choosing and interpreting radiological imaging 1.
From the Research
Prevalence of Thoracic Outlet Syndrome (TOS)
- The prevalence of TOS is estimated to be around 1-3 per 100,000 people 2.
- A study found that the incidence of neurogenic TOS (NTOS) seems to be between 2 and 3 cases per 100,000 people per year, while the incidence of venous TOS (VTOS) is between 0.5 and 1 per 100,000 people per year 3.
- The ratio of NTOS to VTOS is approximately 80:20, while the ratio of those undergoing surgical decompression is about 75:25 3.
- In a metropolitan area of 1,000 people, the rates of NTOS and VTOS are approximately 25 and 8 per year, respectively 3.
Classification of TOS
- TOS can be classified into three types: neurogenic, venous, and arterial, according to the primarily affected structure 2, 4.
- Neurogenic TOS is the most common subtype, characterized by arm and hand pain, paresthesias, and sometimes weakness resulting from compression of the brachial plexus within the thoracic outlet 5, 4.
Diagnosis and Treatment of TOS
- Diagnosis of TOS is often made based on symptoms and physical examination findings, and can be confirmed with imaging studies and electrodiagnostic tests 2, 5, 4.
- Treatment options for TOS include nonsurgical methods such as anti-inflammatory medication, physical therapy, and botulinum toxin injections, as well as surgical treatments like brachial plexus decompression and scalenotomy 2.