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Thoracic outlet syndrome: A neurological and vascular disorder.
[thoracic outlet syndrome]
Thoracic
outlet
syndrome
(
TOS
)
is
a
condition
arising
from
compression
of
the
subclavian
vessels
and
/
or
brachial
plexus
as
the
structures
travel
from
the
thoracic
outlet
to
the
axilla
.
Despite
the
significant
pathology
associated
with
TOS
,
there
remains
some
general
disagreement
among
experts
on
the
specific
anatomy
,
etiology
,
and
pathophysiology
of
the
condition
,
presumably
because
of
the
wide
variation
in
symptoms
that
manifest
in
presenting
patients
,
and
because
of
lack
of
a
definitive
gold
standard
for
diagnosis
.
Symptoms
associated
with
TOS
have
traditionally
been
divided
into
vascular
and
neurogenic
categories
,
a
distinction
based
on
the
underlying
structure
(
s
)
implicated
.
Of
the
two
,
neurogenic
TOS
(
nTOS
)
is
more
common
,
and
typically
presents
as
compression
of
the
brachial
plexus
;
primarily
,
but
not
exclusively
,
involving
its
lower
trunk
.
Vascular
TOS
(
vTOS
)
usually
involves
compression
of
the
vessel
,
most
commonly
the
subclavian
artery
or
vein
,
or
is
secondary
to
thrombus
formation
in
the
venous
vasculature
.
Any
anatomical
anomaly
in
the
thoracic
outlet
has
the
potential
to
predispose
a
patient
to
TOS
.
Common
anomalies
include
variations
in
the
insertion
of
the
anterior
scalene
muscle
(
ASM
)
or
scalenus
minimus
muscle
,
the
presence
of
a
cervical
rib
or
of
fibrous
and
muscular
bands
,
variations
in
insertion
of
pectoralis
minor
,
and
the
presence
of
neurovascular
structures
,
which
follow
an
atypical
course
.
A
common
diagnostic
technique
for
vTOS
is
duplex
imaging
,
which
has
generally
replaced
more
invasive
angiographic
techniques
.
In
cases
of
suspected
nTOS
,
electrophysiological
nerve
studies
and
ASM
blocks
provide
guidance
when
screening
for
patients
likely
to
benefit
from
surgical
decompression
of
TOS
.
Surgeons
generally
agree
that
the
transaxillary
approach
allows
the
greatest
field
of
view
for
first
rib
excision
to
relieve
compressed
vessels
.
Alternatively
,
a
supraclavicular
approach
is
favored
for
scalenotomies
when
the
ASM
impinges
on
surrounding
structures
.
A
combined
supraclavicular
and
infraclavicular
approach
is
preferred
when
a
larger
field
of
view
is
required
.
The
future
of
TOS
management
must
emphasize
the
improvement
of
available
diagnostic
and
treatment
techniques
,
and
the
development
of
a
consensus
gold
standard
for
diagnosis
.
Helical
computed
tomography
offers
a
three
-dimensional
view
of
the
thoracic
outlet
,
and
may
be
valuable
in
the
detection
of
anatomical
variations
,
which
may
predispose
patients
to
TOS
.
This
review
summarizes
the
history
of
TOS
,
the
pertinent
clinical
and
anatomical
presentations
of
TOS
,
and
the
commonly
used
diagnostic
and
treatment
techniques
for
the
condition
.
Diseases
Validation
Diseases presenting
"there remains some general disagreement among experts on the specific anatomy"
symptom
thoracic outlet syndrome
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