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Review
. 2023 May 4;13(9):1625.
doi: 10.3390/diagnostics13091625.

General Overview and Diagnostic (Imaging) Techniques for Neurogenic Thoracic Outlet Syndrome

Stijn B J Teijink  1 , Niels Pesser  1 , Jens Goeteyn  1 , Renée J Barnhoorn  1 , Marc R H M van Sambeek  1   2 , Bart F L van Nuenen  3 , Hugh A Gelabert  4 , Joep A W Teijink  1   5
Affiliations
Review

General Overview and Diagnostic (Imaging) Techniques for Neurogenic Thoracic Outlet Syndrome

Stijn B J Teijink et al. Diagnostics (Basel). .

Abstract

Thoracic outlet syndrome is an uncommon and controversial syndrome. Three different diagnoses can be made based on the compressed structure, arterial TOS, venous TOS, and neurogenic TOS, though combinations do exist as well. Diagnosing NTOS is difficult since no specific objective diagnostic modalities exist. This has resulted in a lot of controversy in recent decades. NTOS remains a clinical diagnosis and is mostly diagnosed based on the exclusion of an extensive list of differential diagnoses. To guide the diagnosis and treatment of TOS, a group of experts published the reporting standards for TOS in 2016. However, a consensus was not reached regarding a blueprint for a daily care pathway in this document. Therefore, we constructed a care pathway based on the reporting standards for both the diagnosis and treatment of NTOS patients. This care pathway includes a multidisciplinary approach in which different diagnostic tests and additional imaging techniques are combined to diagnose NTOS or guide patients in their treatment for differential diagnoses. The aim of the present work is to discuss and explain the diagnostic part of this care pathway.

Keywords: brachial plexus compression; neurogenic thoracic outlet syndrome; thoracic outlet syndrome; thoracic outlet syndrome additional imaging; thoracic outlet syndrome care pathway.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A wedge-sickle sign (blue) seen in high-resolution ultrasound pictures in patients with GSH.
Figure 2
Figure 2
NTOS care pathway.
Figure 3
Figure 3
Thorax aperture showing a short RIGHT (white arrow) and a complete left (white arrow) cervical rib with articulation with the first rib on both sides.
Figure 4
Figure 4
Position during the standardized EAST measurement.
Figure 5
Figure 5
Upper limb tension test. 1: Straight arm in 90-degree abduction; 2: the head is tilted to the unaffected/opposite side of the body; 3: wrist extension; and 4: elbow flexion to a 90-degree angle.
See this image and copyright information in PMC

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