Choosing Surgery for Neurogenic TOS: The Roles of Physical Exam, Physical Therapy, and Imaging

Abstract

Neurogenic thoracic outlet syndrome (nTOS) is characterized by arm and hand pain, paresthesias, and sometimes weakness resulting from compression of the brachial plexus within the thoracic outlet. While it is the most common subtype of TOS, nTOS can be difficult to diagnose. Furthermore, patient selection for surgical treatment can be challenging as symptoms may be vague and ambiguous, and diagnostic studies may be equivocal. Herein, we describe some approaches to aid in identifying patients who would be expected to benefit from surgical intervention for nTOS. We describe the role of physical examination, physical therapy, and imaging in the evaluation and diagnosis of nTOS.

Keywords: imaging; neurogenic thoracic outlet syndrome; physical examination; physical therapy.

Figure 1

3D reconstruction of computed tomography (CT) arteriography, demonstrating a right-sided cervical rib fused to a broadened first thoracic rib, with anterior displacement of the subclavian artery. (A) antero-posterior view; (B) oblique view.