Diagnostic and Therapeutic Management of the Thoracic Outlet Syndrome. Review of the Literature and Report of an Italian Experience

Abstract

The Thoracic Outlet Syndrome is a clinical potentially disabling condition characterized by a group of upper extremity signs and symptoms due to the compression of the neurovascular bundle passing through the thoracic outlet region. Because of the non-specific nature of signs and symptoms, to the lack of a consensus for the objective diagnosis, and to the wide range of etiologies, the actual figure is still a matter of debate among experts. We aimed to summarize the current evidence about the pathophysiology, the diagnosis and the treatment of the thoracic outlet syndrome, and to report a retrospective analysis on 324 patients followed for 5 years at the Padua University Hospital and at the Naples Fatebenefratelli Hospital in Italy, to verify the effectiveness of a specific rehabilitation program for the syndrome and to evaluate if physical therapy could relieve symptoms in these patients.

Keywords: diagnosis; rehabilitation; surgery; thoracic outlet syndrome; treatment.

Figure 1

Anatomical spaces involved in TOS. Originally published in “The human spring approach to thoracic outlet syndrome”. Author: Dr. James Stoxen DC FSSEMM (hon); illustrated and copyrighted by Body Scientific International, LLC – www.BodyScientific.com. Permission of the Author with agreement signed in February 2022.

Figure 2

Estimated marginal means of the NRS-score at T0, T1, and T2. Vertical bars denote the 95% C.I. of means.