The degree of TOS symptoms can be severe. TOS usually develops in patients in their third to fifth decades of life and more commonly in women. However, since its diagnostic criteria have not been elucidated, it is unclear whether the current epidemiologic data underestimate or overestimate the condition. Several studies reported its incidence as 3. Recently, TOS has been classified as arterial vascular, venous vascular, true neurologic, traumatic neurovascular, and disputed types. Neurogenic TOS accounts for over 90% of cases, followed by venous (approximately 3%-5%) and arterial (1%) TOS. TOS can be classified into three types, neurogenic, venous, and arterial, according to the primarily affected structure. This disorder was first reported by Rogers in 1949, although it was more precisely characterized and first termed “TOS” by Rob and Standeven in 1958. Local compression by these structures affects the brachial plexus and subclavian vessels.

The structures involved in TOS are the first rib, scalene muscles, and clavicle. Thoracic outlet syndrome (TOS) is a group of disorders involving compression of the nerves and/or blood vessels in the thoracic outlet region ( i.e., the lower neck and upper chest areas). Clinicians who encounter patients with TOS need to understand its key features to avoid misdiagnosis and provide appropriate treatment. Neuromuscular physicians tend to be skeptical about the existence of disputed TOS, but thoracic surgeons argue that disputed TOS is under-diagnosed. The existence of a disputed TOS remains controversial. Electrodiagnostic and imaging studies are helpful for excluding other possible disorders and confirming the diagnosis of true neurogenic TOS. Since identifying the causative lesions is complex, detailed history taking and thorough clinical investigation are needed. Both true neurogenic and disputed TOS are considered neurogenic TOS. TOS is usually classified into three types, neurogenic, venous, and arterial, according to the primarily affected structure.

We reviewed the pathophysiology, clinical evaluation, differential diagnoses, and treatment of TOS. TOS results in pain, numbness, paresthesia, and motor weakness in the affected upper limb. Most people recover.Thoracic outlet syndrome (TOS) is a group of diverse disorders involving compression of the nerves and/or blood vessels in the thoracic outlet region. Medicines, physical therapy, and relaxation might help. Treatment depends on what caused your TOS.

Repetitive arm and shoulder movements and activity, such as from playing certain sports.

Poor posture that causes nerve compression.

Doctors do nerve and imaging studies to diagnose it. It usually starts between 20 and 50 years of age. If a vein is compressed, your hand might be sensitive to cold, or turn pale or bluish. If a nerve is compressed, you may also feel weakness in your hand.

You may feel burning, tingling, and numbness along your arm, hand, and fingers. The compression can happen between the muscles of your neck and shoulder or between the first rib and collarbone. It happens when the nerves or blood vessels just below your neck are compressed, or squeezed. Thoracic outlet syndrome (TOS) causes pain in the shoulder, arm, and neck.

Thoracic outlet syndrome testing