Understanding Thoracic Outlet Syndrome
TOS involves the compression of the neurovascular bundle as it exits the thoracic girdle. Approximately 95% of all patients suffering from this syndrome are neurogenic (nTOS). nTOS patients often complain of pain and numbness in their fingers, hands, or arms on the affected side. Often as a result of some type of trauma. Often a description of a history of vigorous repetitive activity is encountered. Venous TOS (vTOS) makes up an additional 3–5% of patients, also described as “effort thrombosis” or Paget-Schroetter syndrome. Arterial TOS (aTOS) is the rarest form accounting for only 1-2%.
TOS is often a diagnosis of exclusion. Possible differential diagnosis are herniated cervical disks, rotator cuff injuries, peripheral nerve entrapment, chronic pain syndromes, psychological conditions, multiple sclerosis, hypercoagulable disorders, atrial fibrillation with distal emboli, and upper extremity deep venous thrombosis.
Treatment for nTOS involves a non-operative approach as approximately 60–70% of patients with nTOS can be successfully treated with avoidance of activities that precipitate symptoms, ergonomic modifications to the workplace, and selective use of pharmacologic agents such as nonsteroidal anti-inflammatories, antidepressants, and muscle relaxants. Physical therapy being very important for these patients. 8–12 weeks of conservative treatment should be considered before surgery.