![]() Management options can include surgery, lifestyle modification, pain management, anticoagulation, physical therapy, and rehabilitation. With the wide range of multifactorial etiologies, it also makes sense that best-practice treatments for TOS involve a comprehensive and multi-disciplinary approach. Historically, TOS presents with symptom onset between the ages of 20–50 years old and is more prevalent in women. Neurogenic TOS accounts for over 90% of the cases, followed by venous and arterial etiologies. Several articles report an incidence of 3–80/1000. Because of the wide range of etiologies and lack of expert consensus for diagnostic testing, the true incidence of TOS is difficult to discern. Clinical suspicion can then be confirmed with provocative physical exam maneuvers, radiographic, and/or vascular studies. Diagnosis of TOS is generally dependent on clinician familiarity of TOS coupled with an evaluation of symptoms and patient-specific risk factors. Functional acquired causes can be related to vigorous, repetitive activity associated with sports or work. Traumatic causes most commonly include whip-lash injuries and falls. Examples of congenital etiologies include the presence of a cervical rib or an anomalous first rib. ![]() Furthermore, each one of these subgroups can be related to either congenital, traumatic, or functionally acquired causes. TOS classifications are based on the pathophysiology of symptoms with subgroups consisting of neurogenic (nTOS), venous (vTOS), and arterial (aTOS) etiologies. Compression of this area causes a constellation of distinct symptoms, which can include upper extremity pallor, paresthesia, weakness, muscle atrophy, and pain. These structures include the brachial plexus, subclavian artery, and subclavian vein. The thoracic outlet is an anatomical area in the lower neck defined as a group of three spaces between the clavicle and the first rib through which several important neurovascular structures pass more detailed anatomical descriptions will correspond with discussions of the relevant pathology. Thoracic outlet syndrome (TOS) constitutes a group of diverse disorders that result in compression of the neurovascular bundle exiting the thoracic outlet.
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