Thoracic outlet syndrome (TOS) is caused by compression of the neurovascular bundle at the thoracic outlet which often poses a diagnostic challenge. Patient management is often based on surgeon choice and experience. This study aims to describe practices relating to the diagnosis and management of TOS in the UK over a 1-year period.

This multicenter retrospective UK study included data from 16 vascular centers, analyzing surgical management and postoperative outcomes of patients treated for TOS in 2019. Outcomes were evaluated by TOS type: neurogenic (nTOS), venous (vTOS), or arterial TOS (aTOS).

Data on 133 patients from 16 units were collected over a 1-year period. Most patients were female (87 of 133; 65%). Surgeries addressed nTOS (53 of 133; 40%), vTOS (48 of 133; 36%), and aTOS (32 of 133; 24%), with TOS type unspecified in 2 patients. Five imaging modalities were used for diagnosis. Surgical approaches included supraclavicular (90 of 133; 68%), transaxillary (23 of 133; 17%), infraclavicular (13 of 133; 10%), paraclavicular (6 of 133; 5%), and thoracoscopic (1 of 133; <1%). Pleural injury was the most reported complication (16 of 133; 12%). Most patients with pleural injury were managed conservatively, with only one-quarter requiring the insertion of a chest drain (4 of 16; 25%). Most patients (119 of 133; 89%) had symptom resolution, lower in nTOS compared to arterial and vTOS (P < 0.05).

There is considerable variability in the diagnosis and management of patients with TOS across vascular centers in the UK. This study supports the development of a national registry and the creation of best practice guidelines in the future.

Thoracic outlet syndrome (TOS) encompasses multiple symptoms produced by compression of the neurovascular bundle within the thoracic outlet. The subtypes of thoracic outlet are termed for the major affected structure including neurogenic TOS (nTOS), venous TOS, and arterial TOS. nTOS accounts for >95% of TOS cases and occurs from compression of the brachial plexus. Patients present with numbness, tingling, and upper arm weakness that is reproduced by activities requiring arm elevation or sustained hand use. A diagnosis of nTOS is based on physical examination, electrodiagnostic testing, scalene muscle injection testing, and imaging. Ultrasonographically identifiable changes in the anterior scalene muscle (ASM) in symptomatic patients undergoing treatment for nTOS have not been reported previously. We sought to describe a consistently seen change in the ASM seen on ultrasound imaging in many patients treated for nTOS at our institution.

Symptomatic patients undergoing ASM block for nTOS were imaged using ultrasound examination and compared with a control group of asymptomatic patients. Patients excluded were those who had previously undergone surgical intervention in the neck. Images were randomized and evaluated by four separate observers who regularly treat nTOS to determine if images of symptomatic patients differed from asymptomatic patients. Identifiable abnormalities in the ASM were compared between the groups (n = 50 and n = 50). Twenty separate observers who do not regularly treat nTOS were instructed to delineate the difference between normal and abnormal ASMs after being trained with three normal and three abnormal images. This group of observers was then given a 100-question examination of randomized ultrasound images of ASMs from symptomatic and asymptomatic patients to determine the reproducibility of our findings.

Forty-eight 50 ultrasound images of symptomatic patients' ASMs and 48 of 50 ultrasound images of asymptomatic patients were identified correctly as such by four expert observers (P = .6171). Sensitivity was 96% and specificity was 96%. Twenty nonexpert observers were able to identify muscular abnormalities accurately at a mean rate of 90.55%, with a false-positive rate of 3.65% and false-negative rate of 5.80%.

Patients with symptomatic nTOS demonstrate specific pathological abnormalities in the ASM that are identifiable on ultrasound. Nonexperts can be taught to characterize changes accurately after a short period of instruction.

Lipomas are benign adipocyte tumors that typically present as painless, firm nodules. In rare cases, lipomas may grow near the brachial plexus (BP) and compress various peripheral nerves. This can manifest as upper extremity motor and/or sensory deficits, numbness, tingling, or burning sensations. Surgical intervention of a brachial plexus lipoma (BPL) may be challenging because of variability in location and size. This study reviews previously reported cases of BPL causing neurological impairment and presents 5 additional cases, focusing on operative details and patient outcomes.

A systematic review of PubMed, Scopus, and World of Science was performed to identify all previously reported cases of BP lipomas resulting in neurological deficit. A retrospective review of a neurosurgeon's prospectively collected database was conducted to identify all patients operated on for BPL. Patient demographics, tumor characteristics, presentation, surgical notes, and outcomes were collected for both reviews.

Our literature review yielded 13 articles presenting at least one case meeting the eligibility criteria, resulting in 22 eligible patients. The surgeon's database provided an additional 5 patients meeting the criteria. Of the 27 total cases, 15 were men and 12 were women. The average age was 46.5 with a range of 25 to 70. All patients had upper extremity motor and/or sensory dysfunction preoperatively. Tumors were found in various regions, with the involvement of the supraclavicular fossa reported in 52% of cases. Gross tumor resection was achieved in all but 2 of the 27 operations. Four patients had a nonconventional lipoma type on histology. Sixteen patients experienced complete resolution of neurological symptoms.

BP lipomas are rare but can cause a wide range of neurological symptoms depending on their size and location. A thorough patient examination and imaging studies are essential for creating a successful surgical plan for tumor resection.

Posterior circumflex humeral artery (PCHA) aneurysm is a rare condition, often affecting young professional overhead sports athletes, such as volleyball or baseball players. This condition is one of the manifestations of quadrilateral space syndrome (QSS). We present the case of a 20-year-old former basketball player and recreational swimmer, currently a member of the national team in precision flying, who developed recurrent symptoms of digital ischemia due to a PCHA aneurysm. Despite undergoing computed tomography (CT) imaging, the aneurysm was initially not identified, which delayed proper diagnosis. The patient ultimately underwent surgical treatment, leading to successful resolution of symptoms and return to physical activity. This case underscores the diagnostic challenges of PCHA aneurysm, especially in athletes presenting with unexplained digital ischemia, and emphasizes the need for awareness of this condition among sports medicine and vascular specialists.

Arterial thoracic outlet syndrome (aTOS) is a rare condition, but if undiagnosed, it can have serious consequences for affected patients, up to and including limb loss. Ultrasound could be used here as a widely available method for screening, but it is said to have very high investigator dependence. The fact that ultrasound can be used safely for diagnostic purposes has already been demonstrated. The aim of this study was to evaluate the repeatability of a standardized examination for the diagnosis of aTOS.We recruited inpatients with high-grade suspected arterial thoracic outlet syndrome who were evaluated for invasive therapy at our TOS center. Routine diagnostics were performed according to clinic standards. In addition, 2 sonographers, one highly experienced and one less experienced, performed ultrasound diagnosis according to a standardized protocol. Image acquisition and interpretation were performed independently, and sonographers were mutually blinded. For analysis, the experienced sonographer served as a reference. Agreement between assessors was analyzed using concordance analysis.51 consecutive patients (67% female) aged 39.3±13.0 years were included within 11 months. The standardized ultrasound protocol could be performed in all patients. The prevalence of TOS was high (79.4%; CI: 71.4-87.3%) in our cohort. Ultrasound inter-rater agreement using the standardized protocol was very good at 0.820 (CI: 0.624-1.000).Ultrasound diagnosis of TOS using a standardized protocol can be performed effectively and shows a high agreement between 2 sonographers.

Neurogenic thoracic outlet syndrome (nTOS) is commonly treated with first-rib resection, a procedure linked to postoperative complications, but its necessity remains debated among experts, highlighting the need for further research. This randomized controlled trial aims to compare conventional first-rib resection with the avulsion method to identify the most effective surgical approach.

This single-center, randomized, group-sequential trial compared two surgical approaches for treating nTOS. Participants were randomly assigned to undergo first-rib resection (Group A) or first-rib avulsion (Group B), with both groups blinded to treatment allocation. The University of Sulaimani granted ethical approval and obtained written informed consent. Inclusion criteria included nTOS patients requiring surgery, excluding those with other TOS types, cervical ribs, clavicular fractures, or other complications. Outcome measures included pain scores, numbness, and patient satisfaction at multiple time points. Statistical analysis was performed using SPSS and Microsoft Excel.

A total of 48 female patients were enrolled (23 in Group A, 25 in Group B). The mean age was 32.58 ± 7.23 years, and the average operation duration was 48.27 ± 13.95 min. Group B had significantly longer ribs (P < 0.001). Both groups showed significant pain and numbness reduction, with no significant differences in outcomes (P = 0.647, P = 0.839). At 6 months, 92.0% of Group B and 87.0% of Group A patients recommended the surgery.

Although statistically not significant, first rib avulsion may offer a viable alternative to resection for nTOS, providing comparable pain relief and functional recovery with reduced invasiveness.

Neurogenic thoracic outlet syndrome (NTOS) is characterized by the compression of the brachial plexus in the thoracic outlet region, caused by various etiologies. We report a case with clinical symptoms and imaging findings from ultrasound and magnetic resonance imaging (MRI) of NTOS due to an elongated C7 transverse process and a fibrous band of the middle scalene muscle, which was confirmed in decompression surgery.

Thoracic outlet syndrome (TOS) is a relatively common condition in the United States. It is characterized by numbness or pain radiating down the ulnar aspect of the affected arm. This case report discusses a 76-year-old man who presented to a family medicine clinic with symptoms that caused him significant discomfort. He was seeking medications to alleviate his pain. After osteopathic manipulative treatment (OMT), the patient's symptoms were resolved. The osteopathic techniques utilized included myofascial release, thoracic inlet release (a lymphatic technique), and facilitated positional release. Although the patient reported improved symptomology post-treatment, he was lost to follow-up. This case suggests a potentially positive intervention using OMT for the treatment of a possible case of myofascial-induced TOS.

While hand paresthesia and numbness are commonly associated with nerve compression, these symptoms also manifest in shoulder conditions not typically linked to direct nerve involvement, prompting questions about their underlying causes. This review aimed to explore the existing literature on hand paresthesia and numbness in patients with common shoulder pathologies. The goal was to identify gaps in our understanding of the prevalence and mechanisms behind these symptoms.

To conduct this review, a search strategy was formulated to target key terms related to hand paresthesia, numbness, and various shoulder pathologies. PubMed, Scopus, Embase via OVID, and Cochrane Library were searched, resulting in an initial pool of 33 articles. After screening and removing duplicates, three relevant studies were included for analysis.

Our review analyzed three current studies that demonstrated varying rates of preoperative hand paresthesia and numbness among patients with different shoulder pathologies. Specifically, 54% of patients with subacromial impingement syndrome, 35% of patients with rotator cuff tears, and 40% of patients with either Bankart tears or superior labrum anterior and posterior (SLAP) tears reported experiencing hand paresthesia. Hand numbness was reported by 29% of patients with rotator cuff tears, 40% with Bankart tears, and 55% with superior labrum anterior and posterior tears. The prevalence of hand paresthesia and numbness was positively correlated with higher intensity of shoulder pain among all included studies.

Hand paresthesia and numbness have been reported by patients with subacromial impingement syndrome, rotator cuff tears, and glenohumeral labral tears. The prevalence of hand paresthesia and numbness across other shoulder pathologies and their pathophysiology remain to be investigated.

Somatosensory evoked potentials (SSEPs) are electrical potentials that measure various parts of the ascending somatosensory pathways. They are elicited through stimulating mixed nerves, with subsequent orthodromic stimulation of sensory nerves. Despite advances in imaging, SSEPs complement both the clinical examination and peripheral neurophysiological studies when assessing the functional integrity of the sensory pathways, being especially helpful when imaging is inconclusive. We describe the technique of performing SSEPs and the anatomical substrates of their waveforms, and we highlight important clinical applications both in central and peripheral nervous system disorders.

Thoracic outlet syndrome (TOS) is characterized by intractable cervicobrachial pain caused by strangulation of the brachial plexus and subclavian artery by structures of the superior thoracic outlet. We describe percutaneous epidural adhesiolysis for refractory pain due to TOS. A man in his 40s had received nerve block therapy for right upper extremity pain of unknown origin for 5 years. Although imaging findings were negative for TOS, reproducible pain relieved by injection of a local anesthetic into the anterior scalene muscle suggested TOS due to compression by the muscle. Subsequently, since nerve block treatment had only temporary effect and the pain gradually worsened, right T1 epidural adhesiolysis was performed. Thereafter, the pain improved from a numerical rating scale score of 8-9/10 to 2-3/10, continuing for about 3 months. Epidural adhesiolysis was remarkably effective in treating intractable pain caused by TOS due to strangulation of the brachial plexus by the anterior scalene muscle.

Spontaneous shoulder-girdle pain and scapular winging/dyskinesis can be caused by several neuromuscular disorders identifiable by electrodiagnostic studies (EDX). We describe a group of adolescent athletes with this clinical presentation but normal EDX, followed by later development of neurogenic thoracic outlet syndrome (NTOS).

We identified patients referred for evaluation of NTOS that had a history of chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX. Each was refractory to conservative management and underwent supraclavicular decompression and brachial plexus neurolysis for NTOS. Functional disability was quantified by Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores.

There were 5 female patients with a mean age at symptom onset of 14.2 ± 0.4 years, including spontaneous severe pain in the shoulder, scapula, and arm, along with prominent scapular winging/dyskinesis, and normal EDX. Symptoms had persisted for 18.9 ± 4.0 months prior to referral, with pronounced upper extremity disability (mean QuickDASH, 54.6 ± 6.9). By 3 months after surgical treatment for NTOS, all 5 patients experienced near-complete symptom resolution, including scapular winging/dyskinesis, with markedly improved function (mean QuickDASH, 2.2 ± 1.3) and a return to normal activity.

A subset of patients with chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX may develop dynamic brachial plexus compression characteristic of NTOS, exhibiting an ischemic "Sunderland-zero" nerve conduction block for which surgical decompression can result in rapid and substantial clinical improvement. The presence of surgically treatable NTOS should be considered for selected patients with long-standing scapular winging/dyskinesis who fail conservative management.

Introduction Despite advancements in medical and surgical management, thoracic outlet syndrome (TOS) remains a complex and often understudied condition with variable outcomes. This study assessed hospitalization rates and outcomes, including patient characteristics, mortality risks, and healthcare costs associated with TOS hospitalizations. Methods We analyzed elective and nonelective hospitalization data for TOS between 2010 and 2021 from the National Inpatient Sample (NIS) and National Readmission Databases (NEDS) and classified the data into neurogenic, venous, and arterial subtypes using the International Classification of Diseases (ICD) diagnostic and procedural codes. The primary endpoint of this study was hospital-related all-cause mortality. Secondary outcomes included hospitalization costs, length of hospital stay, in-hospital complications, and 30-day readmissions. The odds of primary and secondary outcomes were assessed using multivariate hierarchical logistic regression analysis. Cox proportional hazard models were used to assess predictors of 30-day readmission. Results A total of 37,174 hospitalizations for TOS were identified in the NIS datasets included in our study. Of these, 7,397 (19.9%) were for venous TOS, 3,346 (9.0%) were for arterial TOS, and 26,430 (71.1%) were for neurogenic TOS. Patients with arterial TOS were significantly older (median age: 66; interquartile range (IQR): 54-77 years) compared with venous (63 years; IQR: 50-74) or neurogenic TOS (58 years; IQR: 53-73; P < 0.001). Scalenectomy, with or without first rib resection, was performed in 18% (6,692) of TOS hospitalizations, mainly in neurogenic TOS (16.7%, 4,405 cases) compared to venous (13%, 964 cases) and arterial TOS (38.1%, 1,273 cases). The median duration of hospitalization for TOS was three days (IQR: two to six days). The mean cost of care for all TOS hospitalizations was $107,481 (standard deviation (SD): $4,158). The mean cost of hospitalization was significantly higher for vascular TOS than neurogenic TOS ($114,824 vs. $98,278; P < 0.001) and for venous TOS than arterial TOS ($119,042 vs. $110,606; P = 0.041). Overall, in-hospital mortality was 446 (1.2%). Mortality rates were significantly higher in venous TOS compared to arterial TOS (263 (59.1%) vs. 182 (40.7%); adjusted hazards ratio (AHR): 1.56; 95% confidence interval (CI): 1.26-3.56; P = 0.041). Black race (adjusted Odds ratio (aOR): 3.86, 95% CI: 8.80-16.90; P = 0.043), deep vein thrombosis (aOR: 1.68, 95% CI: 1.18-2.03; P = 0.018), previous coronary artery bypass graft (aOR: 2.37, 95% CI: 1.84-3.92; P = 0.003), pulmonary embolism (aOR: 2.63, 95% CI: 1.23-3.45; P < 0.001), and postoperative sepsis with multiorgan failure (aOR: 3.33, 95% CI: 2.13-6.40; P = 0.032) were correlated with mortality. Conclusion Hospitalization duration and mortality rates for TOS are generally low, though vascular TOS has a longer length of stay and higher mortality than neurogenic TOS. Mortality was significantly associated with Black race, deep vein thrombosis, previous coronary artery bypass grafting (CABG), pulmonary embolism, and postoperative septicemia.

The presence of additional cervical ribs is a rare and relatively unknown pathology. The brachial plexus is most often compressed. Thoracic Outlet Syndrome (TOS) is the one of discussed of mixed compression syndromes, due to diagnostic difficulties and the lack of evidence to resolve the effectiveness of surgical treatment over conservative treatment.

Presentation of the case of a 22-year-old female athlete with cervical ribs with neurogenic TOS symptoms and presentation of the rehabilitation model and its results. Functional diagnosis included TOS specific clinical tests performed before, immediately after the treatment and one month later. The range of motion (ROM) in the cervical spine, body posture, the pulse on the left and right radial artery, blood pressure on both upper limbs, as well as pain intensity were examined. Management included 8 therapeutic sessions using trigger point therapy, deep tissue massage and cervical rotational manipulations. The maximum muscle relaxation and pain relief (decrease of 3-5 points in VAS) occurred after 5 therapeutic sessions. The rotation and lateral flexion in the cervical spine was significantly improved - the active ROM increased 2,5 in rotation bilaterally and 3,5/4 cm (left/right) in lateral flexion and passive ROM increased 3,5/3 cm (left/right) in rotation and 3.5/4.5 cm (left/right) in lateral flexion. The joint play of the cervical segments was normalized and the result of costo-clavicular test for the right side and the brachial stretch test for the left side become negative while the change of blood pressure in both upper limbs after the therapy as well as after one month was marginal ( ± 1-4 mmHg).

Conservative treatment based on the therapy of trigger points, deep tissue massage and rotational manipulations of the cervical spine appears to be an effective form of management of TOS induced by additional cervical ribs. However, further studies on are required to determine the most effective treatment options in this condition.

This article presents a unique diagnostic test for the neurogenic thoracic outlet syndrome (nTOS). nTOS is one of the most misdiagnosed and controversial medical problems; the diagnosis is clinical, and there are few specific diagnostic criteria for this condition. We would like to share this unique diagnostic modality, the Tafler test, with medical professionals. The Tafler test helps diagnose nTOS, differentiate it from cervical radiculopathy and carpal tunnel syndrome, and effectively tailor treatment for its symptoms. The following case series aims to describe several patients with nTOS who had failed previous treatment with surgery, physical therapy, and analgesics. The implementation of the Tafler test as a treatment modality in combination with osteopathic manipulative treatment (OMT) and physical therapeutic modalities led to significant improvements in treatment efficiency.

Thoracic outlet syndrome is a complex syndrome that manifests with symptoms based on the presumed injury or impairment of the neurovascular structures in the thoracic outlet space with its intricate anatomy and pathophysiology. The thoracic outlet is a specific anatomical region with three distinct anatomical spaces - interscalene triangle, the costoclavicular space, and the retro-pectoralis minor space. Thoracic outlet syndrome is classified into neurogenic, venous, and arterial thoracic outlet syndrome and often poses diagnostic challenge to implicate a specific condition or cause. Many cases of thoracic outlet syndrome can be effectively managed through conservative measures, but patients with refractory symptoms may warrant surgical intervention. Modalities such as intramuscular anesthetic and botulinum toxin injections hold promise as diagnostic, therapeutic, and prognostic procedures. Further research and collaboration are needed to develop algorithms for diagnosis and treatment of thoracic outlet syndrome symptoms. This review aims to explore our understanding of thoracic outlet syndrome, with a focus on current evidence and emerging trends.

We present the case of a 23-year-old woman who reported weakness in the left upper limb, decreased warmth, numbness in the fingers, pain in the clavicular region, and a severe cold sensation in the limb. A thermal imaging camera examination was performed for diagnostic purposes, which guided further diagnostic and therapeutic management towards arterial thoracic outlet syndrome (aTOS). Following surgery and rehabilitation procedures, significant remission of symptoms was achieved and the patient's condition improved. This is the first report on the diagnosis of aTOS using thermal imaging, paving the way for further clinical research into this effective, rapid, and radiation-free method of diagnostic imaging. Conclusion: Thermal imaging is one of the most effective, readily available, and patient-safe methods for diagnosing vascular disease associated with flow disruption.

Thoracic outlet syndrome (TOS) is recognised in approximately 8% of the population. Vascular presentation is rare and diagnosis is often elusive due to its rarity. As episodes of TOS in the upper extremities are rare, proven protocols for rehabilitation management are lacking. The purpose of our article is to present a clinical examination protocol and a treatment protocol for patients after an episode of venous thrombosis in the upper limb (VTOS). We report the case of a middle-aged woman with right venous TOS with pain in the right upper extremity, accompanied by oedema and mild violet discolouration. The results after 10 sessions of physiotherapy were as follows: a reduction in symptoms of approximately 40%, an improvement of approximately 15% in sports performance, and an improvement of approximately 25% in work. There was also an improvement in the results of TOS provocation tests, i.e., a 50-100% improvement in pulse rate and about 30% less discolouration in the extremity. Additionally, there was a significant improvement in posture between the two sides of the upper quadrant. The results after 10 physiotherapy sessions are surprising due to chronic disease after the thrombosis episode. It appears that even after a long period of time since diagnosis, improvement is possible.

Thoracic outlet syndrome is caused by compression of the neurovascular structures within the thoracic outlet leading to a collection of symptoms in the upper limb and shoulder. Identification of the causative factor is essential and thorough clinical examination using specific manoeuvres can aid in the diagnosis of this syndrome. Cervical rib is one of the causes for thoracic outlet syndrome and this manuscript will discuss the thoracic outlet syndrome, cervical rib, incidence, clinical presentation, diagnosis and management including surgical approaches with a focus on transcervical approach.

Thoracic outlet syndrome (TOS) typically considered a condition of the adult population; it is often disregarded in children and adolescents due to its limited recognition within the pediatrics. The current study aims to systematically review and provide insights into TOS among pediatric patients.

PubMed, Scopus, Web of Science, and Google Scholar databases were thoroughly searched for English language studies published until March 15th, 2024. The study included those articles focusing on pediatric or adolescent individuals diagnosed with TOS. Data collected from studies encompassed date of publication, number of participants or reported cases, age (years), gender of participants, type of TOS, affected side, type of treatment, surgical approach, bony abnormality, duration of symptoms (months), outcome, and follow-up time duration (months).

The current study comprised 33 articles, 21 of which were case reports, 10 of which were case series, and the remaining were cohort studies. In this study, 356 patients were included. Females constituted 234 (65.73%) of the patient population. Among TOS types, neurogenic TOS was found among 201 (56.5%) patients. Sporting-related activity or physical activity was present in 193 (54%) patients, followed by a history of trauma in 27 (7%) patients.

Pediatric patients exhibited a higher percentage of vascular TOS than their adult counterparts, with the supraclavicular approach emerging as the preferred treatment method. Sports-related activities were identified as the primary risk factor associated with pediatric TOS.

Objectives: The coexistence of arterial compression with neurogenic thoracic outlet syndrome (TOS) is associated with a better post-surgical outcome. Forearm transcutaneous oxygen pressure (TcpO2) using the minimal decrease from rest of oxygen pressure (DROPmin) can provide an objective estimation of forearm ischemia in TOS. We hypothesized that a linear relationship exists between the prevalence of symptoms (PREVs) and DROPmin during 90° abduction external rotation (AER) provocative maneuvers. Thereafter, we aimed to estimate the proportion of TOS for which arterial participation is present. Methods: Starting in 2019, we simultaneously recorded forearm TcpO2 recordings (PF6000 Perimed®) and the presence/absence of ipsilateral symptoms during two consecutive 30 s AER maneuvers for all patients with suspected TOS. We retrospectively analyzed the relationship between the prevalence of symptoms and DROPmin results. We estimated the number of cases where ischemia likely played a role in the symptoms, assuming that the relationship should start from zero in the absence of ischemia and increase linearly to a plateau of 100% for the most severe ischemia. Results: We obtained 2560 TcpO2 results in 646 subjects (69% females). The correlation between PREVs and DROPmin was 0.443 (p < 0.001). From these results, we estimated the arterial participation in TOS symptoms to be 22.2% of our 1669 symptomatic upper limbs. Conclusions: TcpO2 appears to be an interesting tool to argue for an arterial role in symptoms in TOS. Arterial participation is frequent in TOS. Whether DROPmin could predict treatment outcomes better than the sole presence of compression is an interesting direction for the future.

Thoracic outlet syndrome (TOS) results from compression of the neurovascular bundle in the thoracic outlet. Several etiologies can contribute to the development of thoracic outlet syndrome, including both congenital and acquired causes. Historically, trapezius pathology has not been considered a cause of TOS; however, here we report a patient with neurogenic TOS plus ipsilateral trapezius hypertonicity and hypertrophy who had significant symptomatic improvement following botulinum toxin injections to trapezius.

This study was a scoping review.

Continued advances in musculoskeletal sonography technology and access have increased the feasibility of point-of-care use to support day-to-day clinical care and decision-making. Sonography can help improve therapeutic outcomes in upper extremity (UE) rehabilitation by enabling clinicians to visualize underlying structures during treatment.

This study aimed to (1) evaluate the growth, range, extent, and composition of sonography literature supporting UE rehabilitation; (2) identify trends, gaps, and opportunities with regard to anatomic areas and diagnoses examined and ultrasound techniques used; and (3) evaluate potential research and practice utility.

Searches were completed in PubMed, CINAHL, SPORTDiscus, PsycINFO, and BIOSIS. We included data-driven articles using ultrasound imaging for upper extremity structures in rehabilitation-related conditions. Articles directly applicable to UE rehabilitation were labeled direct articles, while those requiring translation were labeled indirect articles. Articles were further categorized by ultrasound imaging purpose. Article content between the two groups was descriptively compared, and direct articles underwent an evaluation of evidence levels and narrative synthesis to explore potential clinical utility.

Average publication rates for the final included articles (n = 337) steadily increased. Indirect articles (n = 288) used sonography to explore condition etiology, assess measurement properties, inform medical procedure choice, and grade condition severity. Direct articles (n = 49) used sonography to assess outcomes, inform clinical reasoning, and aid intervention delivery. Acute UE conditions and emerging sonography technology were rarely examined, while tendon, muscle, and soft tissue conditions and grayscale imaging were common. Rheumatic and peripheral nerve conditions and Doppler imaging were more prevalent in indirect than direct articles. Among reported sonography service providers, there was a high proportion of nonradiologist clinicians.

Sonography literature for UE rehabilitation demonstrates potential utility in evaluating outcomes, informing clinical reasoning, and assisting intervention delivery. A large peripheral knowledge base provides opportunities for clinical applications; however, further research is needed to determine clinical efficacy and impact for specific applications.

Thoracic outlet syndrome (TOS) involves inconsistent symptoms, presenting a challenge for medical providers to diagnose and treat. Thoracic outlet syndrome is defined as a compression injury to the brachial plexus, subclavian artery or vein, or axillary artery or vein occurring between the cervical spine and upper extremity. Three common subcategories are now used for clinical diagnosis: neurogenic, arterial, and venous. Postural position and repetitive motions such as throwing, weightlifting, and manual labor can lead to symptoms. Generally, TOS is considered a diagnosis of exclusion for athletes due to the poor accuracy of clinical testing, including sensitivity and specificity. Thus, determining a definitive diagnosis and reporting injury is difficult. Current literature suggests there is not a gold standard diagnostic test. Rehabilitation has been shown to be a vital component in the recovery process for neurogenic TOS and for arterial TOS and venous TOS in postoperative situations.

Background: We noted that patients with thoracic outlet syndrome (TOS) have elevation of the ipsilateral scapula and named this the scapular elevation sign (SES). The aim was to determine the prevalence of SES in a normal cohort, compare SES with other provocative tests and to determine the treatment effect on SES. Methods: First, normal asymptomatic subjects were prospectively assessed to determine the prevalence of SES in a normal cohort. Second, patients with TOS were retrospectively examined for the presence of SES and four provocative tests: supraclavicular pressure, scalene test, elevated arm stress test (EAST) and the military brace manoeuvre. All patients were initially treated non-surgically. Surgery was offered to patients with persistent symptoms at 6 months. Patients were re-examined for the presence of the SES after treatment. Results: The prevalence of SES in our normal cohort was 4% (2/53). Our study cohort included 20 patients with TOS. The SES was positive in 18 patients (90%). Supraclavicular pressure was positive in 11 (55%), scalene test in 13 (65%), EAST in 9 (45%) and military brace manoeuvre in 11 patients (55%). Following non-surgical treatment, six patients had symptom resolution, three had improvement, nine persistent symptoms and two were lost to follow-up. The SES was positive in one out of six patients with symptom resolution, two out of three patients with improvement and in all nine patients with persistent symptoms. Patients with persistent symptoms underwent surgery with symptom resolution in eight and improvement in one patient. The SES remained positive in two patients after surgical treatment. Conclusions: The SES is simple and sensitive, does not rely on variations in performance of the test and suitable for diagnosis and assessment of outcomes of TOS. Level of Evidence: Level III (Diagnostic).

Arterial thoracic outlet syndrome (TOS) resulting from thoracic trauma is an exceedingly rare condition, typically caused by a fracture of the first rib or clavicle. In this report, the author presents a case of traumatic arterial TOS precipitated by multiple left rib fractures, notably excluding the first rib, following a fall from a 2-m high stepladder. The patient was treated successfully with first rib resection via a transaxillary approach, and the postoperative course was uneventful. The literature includes no known reports of traumatic arterial TOS in patients with multiple fractures that spare the first rib, making this the first documented case of its kind. In this instance, the patient sustained fractures to the fourth and fifth ribs. The TOS was likely not a direct result of the multiple rib fractures, which were located some distance from the thoracic outlet. Rather, it is hypothesized that the trauma from these fractures caused a soft tissue injury within the thoracic outlet, which ultimately led to the development of TOS.

Droopy shoulder syndrome (DSS) manifests as discomfort or abnormal sensations in the neck, shoulder, chest, and upper limbs, resulting from tension on the brachial plexus caused by abnormally low shoulder positioning. This case report examines the presentation and management of a patient with DSS, a rare but crucial precursor to thoracic outlet syndrome (TOS). The patient, a 22-year-old male, presented with progressive pain and tingling in his left upper limb, shoulder, chest, and neck. Comprehensive examination and imaging studies led to a diagnosis of DSS. Physical therapy prevented progression to full-blown TOS, highlighting the importance of early recognition and intervention. This case underscores the diagnostic challenges and therapeutic strategies essential for managing this syndrome, preventing complications, and restoring patient function.

The overall distribution pattern of intramuscular nerves and the regions with the highest spindle abundance in deep cervical muscles have not been revealed. This study aimed to reveal neuromuscular compartmentalization and localize the body surface position and depth of the center of the region of highest muscle spindle abundance (CRHMSA) in the deep cervical muscles.

This study included 36 adult cadavers (57.7 ± 11.5 years). The curved line joining the lowest point of the jugular notch and chin tip was designated as the longitudinal reference line (line L), and the curved line connecting the lowest point of the jugular notch and acromion was designated as the horizontal reference line (line H). Modified Sihler's staining, hematoxylin-eosin staining and computed tomography scanning were employed to determine the projection points (P) of the CRHMSAs on the anterior surfaces of the neck. The positions (PH and PL) of point P projected onto the H and L lines, and the depth of each CRHMSA, and puncture angle were determined using the Syngo system.

The scalenus posterior and longus capitis muscles were divided into two neuromuscular compartments, while the scalenus anterior and longus colli muscles were divided into three neuromuscular compartments. The scalenus medius muscle can be divided into five neuromuscular compartments. The PH of the CRHMSA of the scalenus muscles (anterior, medius, and posterior), and longus capitis and longus colli muscles, were located at 36.27, 39.18, 47.31, 35.67, and 42.71% of the H line, respectively. The PL positions were at 26.53, 32.65, 32.73, 68.32, and 51.15% of the L line, respectively. The depths of the CRHMSAs were 2.47 cm, 2.96 cm, 2.99 cm, 3.93 cm, and 3.17 cm, respectively, and the puncture angles were 87.13°, 85.92°, 88.21°, 58.08°, and 77.75°, respectively.

Present research suggests that the deep cervical muscles can be divided into neuromuscular compartments; we recommend the locations of these CRHMSA as the optimal target for administering botulinum toxin A injections to treat deep cervical muscle dystonia.

Disputed thoracic outlet syndrome (D.TOS) stands as one of the primary global contributors to physical disability, presenting diagnostic and treatment challenges for patients and frequently resulting in prolonged periods of pain and functional impairment. Mobile applications emerge as a promising avenue in aiding patient self-management and rehabilitation for D.TOS. This study aimed to investigate the impact of a certain mobile application-based rehabilitation on pain relief and the improvement of disability in patients experiencing D.TOS.

Eighty-eight patients diagnosed with D.TOS randomized 1:1 to either the control group (n = 44) or the intervention group (n = 44). Participants in the control group were provided with a brochure containing standard rehabilitation exercise instructions, a written drug prescription from the physician, and guidance on recommended physical activity levels, including home exercises. In contrast, all participants in the intervention group used the mobile application. Disability and pain levels in patients were assessed after six weeks in both groups.

Both groups improved pain and disability based on the scaled measurements. According to the questionnaire scale, the intervention group showed a considerable decline in disability; however, there was a significant difference in just one question (P < 0.05). Furthermore, the intervention group showed significant improvement in neck pain NRS (p = 0.024) compared to the control. Based on the shoulder and head pain numeric rate scale (NRSs), both groups showed improvement in disability conditions; but there were no significant differences between the groups (p > 0.05).

Mobile applications are promising tools for alleviating disabilities and pain in patients with musculoskeletal conditions. This study confirmed the potential of mobile technology to enhance active and corrective physical activity, thereby reducing pain in patients with D.TOS.

Iranian Registry of Clinical Trials (IRCT) with the identifier IRCT20141221020380N3 (http://www.irct.ir/).

Neurogenic thoracic outlet syndrome results from compression of the brachial plexus. The symptoms are mainly pain, upper-limb weakness and paresthesia. Management always starts with a rehabilitation program, but failure of rehabilitation may necessitate surgery. In practice, we observed that several patients developed secondary distal nerve entrapment in the months following surgery, with no preoperative compression. We aimed to assess the occurrence of distal nerve entrapment after surgery for neurogenic thoracic outlet syndrome in a retrospective cohort study. Seventy-four patients were included; 82% females; mean age, 39.4 ± 9.4 years. There were 36.5% with high intensity and 63.5% with low to moderate intensity work. Eighteen (24.3%) developed secondary upper-limb entrapment at 10.6 ± 5.8 months after surgery. Sixteen had a single entrapment and 2 had two different entrapments. In 10 cases (50%) the ulnar nerve was involved at the elbow, in 7 (35.0%) the radial nerve at the radial tunnel, and in 3 (15.0%) the median nerve. No differences were found between patients with and without secondary nerve entrapment in gender (p = 0.51), mean age (p = 0.44), symptom duration (p = 0.92) or work intensity (p = 0.26). Further studies are needed to confirm these results and to shed light on the underlying mechanisms.

Pectoralis minor syndrome (PMS) and quadrilateral space syndrome (QSS) are uncommon neurovascular compression disorders affecting the upper extremity. PMS involves compression under the pectoralis minor muscle, and QSS results from compression in the quadrilateral space-both are classically observed in overhead-motion athletes. Diagnosing PMS and QSS may be challenging due to variable presentations and similarities with other, more common, upper-limb pathologies. Although there is no gold standard diagnostic, local analgesic muscle-block response in a patient with the appropriate clinical context is often all that is required for an accurate diagnosis after excluding more common etiologies. Treatment ranges from conservative physical therapy to decompressive surgery, which is reserved for refractory cases or severe, acute vascular presentations. Decompression generally yields favorable outcomes, with most patients experiencing significant relief and restored baseline function. In conclusion, PMS and QSS, although rare, can cause debilitating upper-extremity symptoms; accurate diagnosis and appropriate treatment offer excellent outcomes, alleviating pain and disability.

The diagnosis and clinical features of thoracic outlet syndrome have long confounded clinicians, owing to heterogeneity in symptom presentation and many overlapping competing diagnoses that are "more common." Despite the advent and prevalence of high-resolution imaging, along with the increasing awareness of the syndrome itself, misdiagnoses and untimely diagnoses can result in significant patient morbidity. The authors aimed to summarize the current concepts in the clinical features and diagnosis of thoracic outlet syndrome.

Thoracic outlet syndrome (TOS) is observed more frequently in women, although the exact causes of this sex disparity remain unclear. By investigating the three types of TOS-arterial, neurogenic, and venous-regarding symptoms, diagnosis, and treatment, this article aims to shed light on the current understanding of TOS, focusing on its variations in women.

Thoracic outlet syndrome (TOS) consists of a group of disorders resulting from compression of the neurovascular bundle exiting through the thoracic outlet. TOS can be classified as follows based on the etiology of the pathophysiology: neurogenic TOS, venous TOS, arterial TOS, and mixed TOS. The constellation of symptoms a patient may experience varies, depending on the structures involved. Due to the wide range of etiologies and presenting symptoms, treatments for TOS also differ. Furthermore, most studies focus on the perioperative and short-term outcomes after surgical decompression for TOS. This systematic review aimed to provide a pooled analysis of studies to better understand the intermediate and long-term outcomes of surgical decompression for TOS. We conducted a systematic literature search in the Ovid MEDLINE, Embase, and Google Scholar databases for studies that analyzed long-term outcomes after surgical decompression for TOS. The inclusion period was from January 2015 to May 2023. The primary outcome was postoperative QuickDASH Outcome Measure scores. A total of 16 studies were included in the final analysis. The differences between postoperative and preoperative QuickDASH Outcome Measure scores were calculated, when possible, and there was a mean overall difference of 33.5 points (95% CI, 25.2-41.8; P = .001) after surgical decompression. There was a higher proportion of excellent outcomes reported for patients undergoing intervention for arterial and mixed TOS etiologies, whereas those with venous and neurogenic etiologies had the lowest proportion of excellent outcomes reported. Patients with neurogenic TOS had the highest proportion of poor outcomes reported. In conclusion, surgical decompression for TOS has favorable long-term outcomes, especially in patients with arterial and mixed etiologies.

The physical demands of sports can place patients at elevated risk of use-related pathologies, including thoracic outlet syndrome (TOS). Overhead athletes in particular (eg, baseball and football players, swimmers, divers, and weightlifters) often subject their subclavian vessels and brachial plexuses to repetitive trauma, resulting in venous effort thrombosis, arterial occlusions, brachial plexopathy, and more. This patient population is at higher risk for Paget-Schroetter syndrome, or effort thrombosis, although neurogenic TOS (nTOS) is still the predominant form of the disease among all groups. First-rib resection is almost always recommended for vascular TOS in a young, active population, although a surgical benefit for patients with nTOS is less clear. Practitioners specializing in upper extremity disorders should take care to differentiate TOS from other repetitive use-related disorders, including shoulder orthopedic injuries and nerve entrapments at other areas of the neck and arm, as TOS is usually a diagnosis of exclusion. For nTOS, physical therapy is a cornerstone of diagnosis, along with response to injections. Most patients first undergo some period of nonoperative management with intense physical therapy and training before proceeding with rib resection. It is particularly essential for ensuring that athletes can return to their baselines of flexibility, strength, and stamina in the upper extremity. Botulinum toxin and lidocaine injections in the anterior scalene muscle might predict which patients will likely benefit from first-rib resection. Athletes are usually satisfied with their decisions to undergo first-rib resection, although the risk of rare but potentially career- or life-threatening complications, such as brachial plexus injury or subclavian vessel injury, must be considered. Frequently, they are able to return to the same or a higher level of play after full recovery.

The optimal surgical approach to treat neurogenic thoracic outlet syndrome (nTOS) depends on the individual patient's anatomy as well as the surgeon's experience. The authors present a minimally invasive posterior approach for the resection of a prominent transverse process to reduce local muscular trauma.

A 19-year-old female presented with painful sensations in the right arm and severe fine-motor skill dysfunction in the right hand, each of which had been present for several years. Further examination confirmed affected C8 and T1 areas, and imaging showed an elongated C7 transverse process displacing the lower trunk of the brachial plexus. Decompression of the plexus structures by resection of the C7 transverse process was indicated, owing to persistent neurological effects. Surgery was performed using a minimally invasive posterior approach in which the nuchal soft tissue was bluntly dissected by dilatators and resection of the transverse process was done microscopically through a tubular retractor. The postoperative course showed a sufficient reduction of pain and paresthesia.

The authors describe a minimally invasive posterior approach for the treatment of nTOS with the aim of providing indirect relief of strain on brachial plexus structures. The advantages of this technique include a small skin incision and minor soft tissue damage.

Thoracic outlet syndrome (TOS) is a rare disorder mostly seen in younger individuals. Although patient wellbeing is relevantly impaired, it often takes a long time before the diagnosis is made. Digital subtraction angiography (DSA) is routinely used despite its radiation exposure, which is a major concern in this young patient population. Moreover, DSA offers limited opportunities for functional assessment. By contrast, ultrasonography is widely accessible without causing radiation exposure and allows for flexible functional assessment. The main goal of the study was to investigate whether ultrasound (US) was a viable alternative to DSA in diagnosing arterial TOS (aTOS).

Patients, referred to a tertiary centre for evaluation of suspected TOS, were recruited into the study. DSA was routinely performed with the patient's arms both in the raised (abducted) and neutral (adducted) position. Two vascular surgeons and two radiologists assessed the resulting images for the presence of aTOS. Additionally, two examiners performed US according to a standardised protocol. The reference for presence of aTOS was the DSA based interdisciplinary vascular conference consensus. Inter-rater agreement and latent class analysis (LCA) were performed between assessors and diagnostic methods.

Fifty one consecutive patients (two thirds female) aged 39.3 ± 13.0 years were included within 11 months. US agreement was excellent at 0.94 (0.841-0.980), DSA agreement for vascular surgeons was good at 0.779 (0.479-1.000), whereas it was moderate at 0.546 (0.046-1.000) for radiologists. Results suggest that DSA is untenable as the gold standard for aTOS diagnosis. In LCA, US was shown to be a reliable diagnostic tool for the detection of aTOS.

US examination is a valid test for the detection of haemodynamically relevant compression of arteries in the diagnostic work up of aTOS using a standardised protocol. The role of DSA as the gold standard should be reviewed and needs to be reconsidered.

With a wide range of etiologies, low back pain (LBP) presents a true clinical challenge, finding its origins both in intrinsic spinal and systemic conditions, as well as referred ones. This review categorizes the LBP into these three groups and aims to offer a comprehensive look at the tools required to diagnose and differentiate them. The intrinsic etiologies are based on conditions that affect the musculoskeletal components of the lumbar spine, such as intervertebral disc disease, stenosis, muscular imbalance, and facet joint degeneration. The systemic causes usually extend beyond local structures. Such are the cases of neoplasia, infections, and chronic inflammation. The diagnosis is rendered even more complex by adding the referred pain, which only manifests in the lower back yet arises in more distant locations. By synthesizing the literature that encompasses the problem, this review aims to augment the understanding of the differential diagnoses of LBP by showcasing the subject's nuances. This categorization provides a structured approach to a patient-centered diagnosis, which could facilitate the medical practitioners' efforts to navigate this pathology more effectively.

Neurogenic Thoracic Outlet Syndrome (nTOS) describes a complex of symptoms caused by the compression of neural structures at the upper thoracic outlet. Typical symptoms include pain, numbness and motor weakness of the affected extremity. The incidence of nTOS is 2-3 per 100,000 and is highest between the ages of 25 and 40. There are only a few studies evaluating the surgical outcomes of nTOS in adolescent patients. In particular, there is a lack of long-term data.

In a retrospective study of nTOS cases receiving surgical treatment in our clinic between 2002 and 2021, eight patients between 15 and 18 years of age were included. Demographic data, risk factors, clinical symptoms, clinical functional tests, neurophysiological, radiological and intraoperative findings were evaluated. Postoperative data were recorded using a standardised questionnaire. Decompression of the inferior truncus and the C8 and Th1 nerve roots was performed via a supraclavicular approach.

The average duration of symptoms before surgery was two years. Of the eight patients who underwent surgery, six answered the written questionnaire and could be analysed for the study. The average follow-up was nine years (1-18 years). After surgery, all patients experienced pain reduction; three were pain-free in the long run and five no longer required pain medication. Strength improved in all patients, but two patients still had mild motor deficits. Sensory disturbances were reduced in all patients, but residual hypoesthesia persisted in five. With regard to overhead work, half of the patients had no impairment after surgery. All patients were able to work at the time of the survey. Half of the patients pursued their sports activities without impairment, while mild impairment was reported by the other half.

nTOS in adolescents is a rare compression syndrome. Decompression of the lower parts of the brachial plexus using a supraclavicular approach without resection of the first rib is an adequate treatment. This retrospective study showed that a reduction in pain was achieved in all patients. In some patients, slight sensory and motor disturbances as well as a certain restriction in overhead work persisted. Patients were able to return to sports.

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

Acroparesthesia is a symptom characterized by a subjective sensation, such as numbness, tingling, prickling, and reduced sensation, affecting the extremities (fingers and toes). Despite its frequency, data regarding its diagnostic approach and management are scarce. The etiological diagnosis of acroparesthesia is sometimes challenging since it can be due to abnormality anywhere along the sensory pathway from the peripheral nervous system to the cerebral cortex. Acroparesthesia can reveal several diseases. It can be associated with rheumatic complaints such as arthritis or myalgia. Further cautions are required when paresthesia is acute (within days) in onset, rapidly progressive, severe, asymmetric, proximal, multifocal, or associated with predominant motor signs (limb weakness) or severe dysautonomia. Acroparesthesia may reveal Guillain-Barré syndrome or vasculitis, requiring rapid management. Acroparesthesia is a predominant symptom of polyneuropathy, typically distal and symmetric, often due to diabetes. However, it can occur in other diseases such as vitamin B12 deficiency, monoclonal gammopathy of undetermined significance, or Fabry's disease. Mononeuropathy, mainly carpal tunnel syndrome, remains the most common cause of acroparesthesia. Ultrasonography contributes to the diagnosis of nerve entrapment neuropathy by showing nerve enlargement, hypoechogenic nerve, and intraneural vascularity. Besides, it can reveal its cause, such as space-occupying lesions, anatomical nerve variations, or anomalous muscle. Ultrasonography is also helpful for entrapment neuropathy treatment, such as ultrasound-guided steroid injection or carpal tunnel release. The management of acroparesthesia depends on its causes. This article aimed to review and summarize current knowledge on acroparesthesia and its causes. We also propose an algorithm for the management of acroparesthesia.

The purpose of this report was to describe a patient with a Pancoast tumor who presented for chiropractic care with neck and arm pain.

A 52-year-old male patient with right-sided cervicothoracic pain and numbness in the right upper extremity presented to a chiropractic office for care. The patient reported an occupational history of repetitive lifting motions and overuse injuries. The patient denied history of smoking at the time of presentation.

Radiographic imaging revealed tracheal deviation. A chest computed tomography image demonstrated a large lesion in the apex of the right lung, suggestive of bronchogenic carcinoma. The patient was referred to an oncology clinic, where he admitted to having a 20-year history of smoking. The diagnosis of adenocarcinoma was made via biopsy, and the oncologist's evaluation confirmed the cancer to be stage IIIC. The patient received palliative care treatments, as the advanced state of his condition determined that he was not a candidate for surgical intervention.

Chiropractors and other first-contact health care providers must keep in mind unusual presentations masquerading as common conditions. This case demonstrates the importance of including apical lung tumors in the differential diagnosis of unilateral arm and neck pain and neurologic deficits of the upper extremity. This case demonstrates the importance of thorough follow-up on images ordered, including the ordering clinicians viewing the images themselves.

The thoracic outlet syndrome is characterized by compression of the brachial plexus or subclavian vessels due to anatomical alterations of the thoracic cavity. Vascular presentation is rare and includes thromboembolism and edema in the upper limb, and the diagnosis is often elusive due to its rarity. In this case, we describe a vascular thoracic outlet syndrome presentation whose diagnosis through angiography was achieved after a mechanical thrombectomy.

We report a 43-year-old female patient with pain in the right upper limb, accompanied by edema and mild violet discoloration, without risk factors for hypercoagulability, with D-dimer levels within normal values. Mechanical thrombectomy with AngioJET was performed via an endovascular approach, with the extraction of multiple clots, confirming the presence of thoracic outlet syndrome as the underlying cause of the current condition.

Venous thoracic outlet syndrome is a challenging entity to diagnose; however, it should be considered in cases of deep vein thrombosis of the subclavian vein and confirmed by angiography after a thrombectomy.

Thoracic outlet syndrome (TOS) is related to the compression and/or the traction of the upper-limb neurovascular bundle, responsible for a chronic painful impairment. Neurogenic TOS (NTOS) is the most common manifestation. It remains a challenging diagnosis and its treatment is also difficult. Botulinum toxin (BTX) has been described to help both the diagnosis and the symptoms improvement.

A systematic literature research was performed using PubMed, ScienceDirect, and Embase databases to collect studies reporting the use of BTX in NTOS management. We followed the PRISMA guidelines, and the included studies were evaluated using the GRADE approach.

We included 10 original articles representing 555 patients. Various outcomes were considered, and results varied from a study to another. Symptoms relief varied from an absence of BTX effectiveness to 84.1% of improvement; relief duration was also reported from none to 88 days. BTX injections were debatable predictors of surgical procedure successes due to low evidence. There was a huge gap between the studies concerning side-effects of the BTX procedures, from none to 100% of the patients.

There is no evidence for considering BTX injection as a validated tool for the management of NTOS. There might be a slight effect on symptoms, but outcomes are very variable, which prevents further interpretations. The use of BTX should be evaluated in larger prospective cohorts with more standardized outcomes.

This case study evaluates the diagnosis and treatment of a 12 year old Caucasian male gymnast who had several diagnoses including an isolated first rib fracture, resultant pseudoarthrosis of the first rib, and the development of symptomatic thoracic outlet syndrome. We discuss the causes, prevalence, and suggestions for prompt diagnosis and treatment of these conditions in pediatric patients. Although all three conditions are rare in a child, this case highlights the importance of having a high clinical index of suspicion in recurrent pain in pre-pubertal athletes.

A 12 year old Caucasian male underwent several years of conservative treatment with physical therapy and rest without resolution of his left shoulder pain. He was subsequently diagnosed with pseudoarthrosis of the first rib and thoracic outlet syndrome, which was curative by surgical removal of the first rib, and allowed him to return to his baseline activity level.

Since each of these diagnoses are rare, especially in the pediatric population, we aim to educate the medical community on the prompt diagnosis and treatment of these conditions.

Thoracic outlet syndrome (TOS) often necessitates surgical intervention to alleviate neurovascular bundle compression, which can result in severe postoperative pain. The myriad of surgical techniques available for TOS treatment, the intricate involvement of diverse sensory pathways, and the limited literature on effective analgesic methods for these specific cases underscore the need for successful approaches. This report introduces an efficacious multimodal analgesic strategy that incorporates the erector spinae plane (ESP) block to enhance postoperative pain management after a supraclavicular surgical approach. By combining this fascial block with a comprehensive rationale for its implementation, this case offers valuable insights into improving the postoperative care of TOS patients, ultimately aiming to enhance their comfort and recovery.

Shoulder joint pain is a complex and prevalent clinical concern affecting individuals across various ages and lifestyles. This review delves into the pivotal role of high-resolution imaging techniques, namely ultrasound and magnetic resonance imaging (MRI), in the comprehensive assessment and management of shoulder joint pain. We explore the anatomical foundations of the shoulder, common etiologies of pain, and the significance of precise diagnosis. High-resolution imaging facilitates the identification of various shoulder pathologies and is crucial in treatment planning, surgical interventions, and long-term prognosis assessment. We examine emerging technologies, discuss challenges and limitations, and chart potential future developments, emphasizing the ongoing evolution of imaging in this critical healthcare domain. In conclusion, high-resolution imaging is an indispensable tool, continually advancing to meet the diagnostic and therapeutic needs of individuals grappling with shoulder joint pain.

Post-operative pain control in thoracic outlet decompression (TOD) is difficult due to the complex innervation of the anatomical region. Poor post-operative pain control has been associated with worse patient experiences and prolonged inpatient stays. This study aims to identify evidence-based peri-operative analgesic strategies for thoracic outlet decompression.

MEDLINE and Embase searches were performed to identify literature assessing peri-operative pain control methods in patients undergoing TOD. Studies were limited to the English language and within 10 years of publication. Abstracts were screened for relevance by two reviewers and identified review articles on thoracic outlet decompression were also included for critical appraisal.

The primary literature search yielded 124 studies whose abstracts were screened resulting in a total of 16 studies being included for full review and critical appraisal. This included 1 randomised control trial, 7 retrospective cohort studies, 1 case series study, 2 case report study and 5 review articles. Studies utilised a baseline of multimodal oral analgesics with their main investigative focus centred on the use of different methods of peripheral nerve blockade.

There is only 1 published randomised controlled trial study investigating postoperative analgesic modalities in thoracic outlet decompression. This deficit of evidence was reflected in the high variation of pain management strategies employed in the published literature. Evidence should be sought to assess the relative efficacy of the various pain management strategies.

Thoracic outlet syndrome is a group of disorders that affect the upper extremity and neck, resulting in compression of the neurovascular bundle that exits the thoracic outlet. Depending on the type of compressed structure, the arterial, venous, and neurogenic forms of TOS are distinguished. In some populations, e.g., in certain groups of athletes, some sources report incidence rates as high as about 80 cases per 1000 people, while in the general population, it is equal to 2-4 per 1000. Although the pathogenesis of this condition appears relatively simple, there are a very large number of overlapping risk factors that drive such a high incidence in certain risk groups. Undoubtedly, a thorough knowledge of them and their etiology is essential to estimate the risk of TOS or make a quick and accurate diagnosis.