Thoracic Outlet Syndrome

  • Scott Laker
  • William J. Sullivan
  • Thomas A. Whitehill

Thoracic outlet syndrome (TOS) is a neurovascular entrapment syndrome of the upper extremity. It is most broadly separated into vasculogenic (V-TOS) and neurogenic (N-TOS) subtypes. TOS occurs relatively rarely in sports but can be devastating when it does.


Carpal Tunnel Syndrome Brachial Plexus Complex Regional Pain Syndrome Thoracic Outlet Syndrome Brachial Plexus Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Peet RM, Henriksen JD, Anderson TP, Martin GM. Thoracic-outlet syndrome: evaluation of a therapeutic exercise program. Proc Staff Meet Mayo Clin 1956;31(9):281–7.PubMedGoogle Scholar
  2. 2.
    Charon JP, Milne W, Sheppard DG, Houston JG. Evaluation of MR angiographic technique in the assessment of thoracic outlet syndrome. Clin Radiol 2004;59(7):588–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Divi V, Proctor MC, Axelrod DA, Greenfield LJ. Thoracic outlet decompression for subclavian vein thrombosis: experience in 71 patients. Arch Surg 2005;140(1):54–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Balci AE, Balci TA, Cakir O, et al. Surgical treatment of thoracic outlet syndrome: effect and results of surgery. Ann Thorac Surg 2003;75(4):1091–6; discussion 6.PubMedCrossRefGoogle Scholar
  5. 5.
    Gilliatt RW. Thoracic outlet syndrome. BMJ 1983;287(6394):764.PubMedCrossRefGoogle Scholar
  6. 6.
    Vercellio G, Baraldini V, Gatti C, et al. Thoracic outlet syndrome in paediatrics: clinical presentation, surgical treatment, and outcome in a series of eight children. J Pediatr Surg 2003;38(1):58–61.PubMedCrossRefGoogle Scholar
  7. 7.
    Wilbourn AJ. The thoracic outlet syndrome is overdiagnosed. Arch Neurol 1990;47(3):328–30.PubMedGoogle Scholar
  8. 8.
    Roos DB. The thoracic outlet syndrome is underrated. Arch Neurol 1990;47(3):327–8.PubMedGoogle Scholar
  9. 9.
    Brantigan CO, Roos DB. Diagnosing thoracic outlet syndrome. Hand Clin 2004;20(1):27–36.PubMedCrossRefGoogle Scholar
  10. 10.
    Redenbach DM, Nelems B. A comparative study of structures comprising the thoracic outlet in 250 human cadavers and 72 surgical cases of thoracic outlet syndrome. Eur J Cardiothorac Surg 1998;13(4):353–60.PubMedCrossRefGoogle Scholar
  11. 11.
    Sanders RJ. Thoracic Outlet Syndrome: A Common Sequelae of Neck Injuries. Philadelphia: Lippincott; 1992.Google Scholar
  12. 12.
    Cheng SW, Reilly LM, Nelken NA, et al. Neurogenic thoracic outlet decompression: rationale for sparing the first rib. Cardiovasc Surg 1995;3(6):617–23; discussion: 24.PubMedCrossRefGoogle Scholar
  13. 13.
    Sanders RJ, Hammond SL. Etiology and pathology. Hand Clin 2004;20(1):23–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Strukel RJ, Garrick JG. Thoracic outlet compression in athletes a report of four cases. Am J Sports Med 1978;6(2):35–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Karas SE. Thoracic outlet syndrome. Clin Sports Med 1990;9(2):297–310.PubMedGoogle Scholar
  16. 16.
    Esposito MD, Arrington JA, Blackshear MN, et al. Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA. J Magn Reson Imaging 1997;7(3):598–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Safran MR. Nerve injury about the shoulder in athletes. Part 2: Long thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet syndrome. Am J Sports Med 2004;32(4):1063–76.PubMedCrossRefGoogle Scholar
  18. 18.
    Simovitch RW, Bal GK, Basamania CJ. Thoracic outlet syndrome in a competitive baseball player secondary to the anomalous insertion of an atrophic pectoralis minor muscle: a case report. Am J Sports Med 2006;34(6):1016–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Juvonen T, Satta J, Laitala P, et al. Anomalies at the thoracic outlet are frequent in the general population. Am J Surg 1995;170(1):33–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Roos DB. Congenital anomalies associated with thoracic outlet syndrome: anatomy, symptoms, diagnosis, and treatment. Am J Surg 1976;132(6):771–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Roos DB. New concepts of thoracic outlet syndrome that explain etiology, symptoms, diagnosis, and treatment. Vasc Surg 1979;13:313–21.Google Scholar
  22. 22.
    Landry GJ, Moneta GL, Taylor LM Jr, et al. Long-term functional outcome of neurogenic thoracic outlet syndrome in surgically and conservatively treated patients. J Vasc Surg 2001;33(2):312–7; discussion 7–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Donaghy M, Matkovic Z, Morris P. Surgery for suspected neurogenic thoracic outlet syndromes: a follow up study. J Neurol Neurosurg Psychiatry 1999;67(5):602–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Yavuzer S, Atinkaya C, Tokat O. Clinical predictors of surgical outcome in patients with thoracic outlet syndrome operated on via transaxillary approach. Eur J Cardiothorac Surg 2004;25(2):173–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Franklin GM, Fulton-Kehoe D, Bradley C, Smith-Weller T. Outcome of surgery for thoracic outlet syndrome in Washington state workers’ compensation. Neurology 2000;54(6):1252–7.PubMedGoogle Scholar
  26. 26.
    McGough EC, Pearce MB, Byrne JP. Management of thoracic outlet syndrome. J Thorac Cardiovasc Surg 1979;77(2):169–74.PubMedGoogle Scholar
  27. 27.
    Gillard J, Perez-Cousin M, Hachulla E, et al. Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine 2001;68(5):416–24.PubMedCrossRefGoogle Scholar
  28. 28.
    Kuschner SH, Fechter JD. Thoracic outlet syndrome: diagnosis and treatment: operative techniques in sports medicine. Orthopedics 1996;4(1):2–7.Google Scholar
  29. 29.
    Demondion X, Bacqueville E, Paul C, et al. Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations. Radiology 2003;227(2):461–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Prandoni P, Polistena P, Bernardi E, et al. Upper-extremity deep vein thrombosis: risk factors, diagnosis, and complications. Arch Intern Med 1997;157(1):57–62.PubMedCrossRefGoogle Scholar
  31. 31.
    Seror P. Medial antebrachial cutaneous nerve conduction study, a new tool to demonstrate mild lower brachial plexus lesions: a report of 16 cases. Clin Neurophysiol 2004;115(10):2316–22.PubMedCrossRefGoogle Scholar
  32. 32.
    Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery 2004;55(4):897–902; discussion 902–3.PubMedCrossRefGoogle Scholar
  33. 33.
    Dumitru D, Zwarts M. Electrodiagnostic Medicine. 2nd ed. Philadelphia: Hanley & Belfus; 2002.Google Scholar
  34. 34.
    Tolson TD. “EMG” for thoracic outlet syndrome. Hand Clin 2004;20(1):37–42, vi.PubMedCrossRefGoogle Scholar
  35. 35.
    Cuevas-Trisan RL, Cruz-Jimenez M. Provocative F waves may help in the diagnosis of thoracic outlet syndrome: a report of three cases. Am J Phys Med Rehabil 2003;82(9):712–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Seror P. Frequency of neurogenic thoracic outlet syndrome in patients with definite carpal tunnel syndrome: an electrophysiological evaluation in 100 women. Clin Neurophysiol 2005;116(2):259–63.PubMedCrossRefGoogle Scholar
  37. 37.
    Machleder HI, Moll F, Nuwer M, Jordan S. Somatosensory evoked potentials in the assessment of thoracic outlet compression syndrome. J Vasc Surg 1987;6(2):177–84.PubMedCrossRefGoogle Scholar
  38. 38.
    Aminoff MJ. Use of somatosensory evoked potentials to evaluate the peripheral nervous system. J Clin Neurophysiol 1987;4(2):135–44.PubMedCrossRefGoogle Scholar
  39. 39.
    Cakmur R, Idiman F, Akalin E, et al. Dermatomal and mixed nerve somatosensory evoked potentials in the diagnosis of neurogenic thoracic outlet syndrome. Electroencephalogr Clin Neurophysiol 1998;108(5):423–34.PubMedCrossRefGoogle Scholar
  40. 40.
    Novak CB, Collins ED, Mackinnon SE. Outcome following conservative management of thoracic outlet syndrome. J Hand Surg [Am] 1995;20(4):542–8.CrossRefGoogle Scholar
  41. 41.
    Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet 1973;2(7825):359–62.PubMedCrossRefGoogle Scholar
  42. 42.
    Crosby CA, Wehbe MA. Conservative treatment for thoracic outlet syndrome. Hand Clin 2004;20(1):43–9, vi.PubMedCrossRefGoogle Scholar
  43. 43.
    Lindgren KA, Oksala I. Long-term outcome of surgery for thoracic outlet syndrome. Am J Surg 1995;169(3):358–60.PubMedCrossRefGoogle Scholar
  44. 44.
    Atasoy E. Thoracic outlet compression syndrome. Orthop Clin North Am 1996;27(2):265–303.PubMedGoogle Scholar
  45. 45.
    Jordan SE, Ahn SS, Freischlag JA, et al. Selective botulinum chemodenervation of the scalene muscles for treatment of neurogenic thoracic outlet syndrome. Ann Vasc Surg 2000;14(4):365–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Kenny RA, Traynor GB, Withington D, Keegan DJ. Thoracic outlet syndrome: a useful exercise treatment option. Am J Surg 1993;165(2):282–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Molina JE, Hunter DW, Dietz CA. Paget-Schroetter syndrome treated with thrombolytics and immediate surgery. J Vasc Surg 2007;45(2):328–34.PubMedCrossRefGoogle Scholar
  48. 48.
    Shebel ND, Marin A. Effort thrombosis (Paget-Schroetter syndrome) in active young adults: current concepts in diagnosis and treatment. J Vasc Nurs 2006;24(4):116–26.PubMedCrossRefGoogle Scholar
  49. 49.
    Melby SJ, Vedantham S, Narra VR, et al. Comprehensive surgical management of the competitive athlete with effort thrombosis of the subclavian vein (Paget-Schroetter syndrome). J Vasc Surg 2008;47(4):809–20; discussion 21.PubMedCrossRefGoogle Scholar
  50. 50.
    Doyle A, Wolford HY, Davies MG, et al. Management of effort thrombosis of the subclavian vein: today’s treatment. Ann Vasc Surg 2007;21(6):723–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Urschel HC Jr, Patel AN. Paget-Schroetter syndrome therapy: failure of intravenous stents. Ann Thorac Surg 2003;75(6):1693–6; discussion 6.PubMedCrossRefGoogle Scholar
  52. 52.
    Tilney ML, Griffiths HJ, Edwards EA. Natural history of major venous thrombosis of the upper extremity. Arch Surg 1970;101(6):792–6.PubMedGoogle Scholar
  53. 53.
    Roos DB. Transaxillary approach for first rib resection to relieve thoracic outlet syndrome. Ann Surg 1966;163(3):354–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Sanders RJ, Hammond SL. Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome. J Vasc Surg 2002;36(1):51–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Urschel HC Jr, Razzuk MA. Neurovascular compression in the thoracic outlet: changing management over 50 years. Ann Surg 1998;228(4):609–17.PubMedCrossRefGoogle Scholar
  56. 56.
    Fulford PE, Baguneid MS, Ibrahim MR, et al. Outcome of transaxillary rib resection for thoracic outlet syndrome—a 10 year experience. Cardiovasc Surg 2001;9(6):620–4.PubMedCrossRefGoogle Scholar
  57. 57.
    Urschel HC Jr, Razzuk MA. Upper plexus thoracic outlet syndrome: optimal therapy. Ann Thorac Surg 1997;63(4):935–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Ellison DW, Wood VE. Trauma-related thoracic outlet syndrome. J Hand Surg [Br] 1994;19(4):424–6.CrossRefGoogle Scholar
  59. 59.
    Goff CD, Parent FN, Sato DT, et al. A comparison of surgery for neurogenic thoracic outlet syndrome between laborers and nonlaborers. Am J Surg 1998;176(2):215–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Leffert RD, Perlmutter GS. Thoracic outlet syndrome: results of 282 transaxillary first rib resections. Clin Orthop 1999;(368):66–79.Google Scholar
  61. 61.
    Dale WA. Thoracic outlet compression syndrome: critique in 1982. Arch Surg 1982;117(11):1437–45.PubMedGoogle Scholar
  62. 62.
    Wilbourn AJ. Thoracic outlet syndrome surgery causing severe brachial plexopathy. Muscle Nerve 1988;11(1):66–74.PubMedCrossRefGoogle Scholar
  63. 63.
    Leffert RD. Complications of surgery for thoracic outlet syndrome. Hand Clin 2004;20(1):91–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Atasoy E. Recurrent thoracic outlet syndrome. Hand Clin 2004;20(1):99–105.PubMedCrossRefGoogle Scholar
  65. 65.
    Ambrad-Chalela E, Thomas GI, Johansen KH. Recurrent neurogenic thoracic outlet syndrome. Am J Surg 2004;187(4):505–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Scott Laker
    • 1
  • William J. Sullivan
    • 2
  • Thomas A. Whitehill
    • 3
  1. 1.Department of RehabilitationUniversity of WashingtonSeattleUSA
  2. 2.Department of Physical Medicine and RehabilitationUniversity of Colorado at Denver and Health Sciences CenterAuroraUSA
  3. 3.Division of Vascular SurgeryUniversity of Colorado Denver School of MedicineAuroraUSA

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