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Diagnosis of Thoracic Outlet Syndrome


The clinical presentation of the thoracic outlet syndrome (TOS) depends on the specific structures compressed, giving rise to three distinct conditions: neurogenic TOS, venous TOS, and arterial TOS. All three types are rare conditions, and diagnosis dependd on clinical suspicion, pattern recognition, and exclusion of more common diseases that have overlapping features. A provisional diagnosis can usually be made or excluded on the basis of clinical history, description of symptoms, and physical examination, supplemented by a limited number of diagnostic studies.

Neurogenic Thoracic Outlet Syndrome

An accurate diagnosis of neurogenic TOS remains a significant challenge, yet properly identified patients respond quite well to treatment. A set of provisional criteria exist for the clinical diagnosis of neurogenic TOS ( Box 1 ).

BOX 1
Provisional Criteria for the Clinical Diagnosis of Neurogenic Thoracic Outlet Syndrome

Unilateral or Bilateral Upper Extremity Symptoms

  • Present for at least 12 weeks

  • Extend beyond the distribution of a single cervical nerve root or peripheral nerve

  • Not satisfactorily explained by another condition

  • Meeting at least one criterion in at least four of the following five categories:

Principal Symptoms

  • Pain in the neck, upper back, shoulder, arm, and/or hand

  • Numbness, paresthesias, and/or weakness in the arm, hand, or digits

Symptom Characteristics

  • Pain, paresthesias, or weakness exacerbated with elevated arm positions

  • Pain, paresthesias, or weakness exacerbated with prolonged or repetitive arm or hand use or by prolonged work on a keyboard or other repetitive strain

  • Pain or paresthesias radiate down the arm from the supraclavicular or infraclavicular space

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