Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is the constellation of symptoms caused by compression of neurovascular structures in the thoracic outlet. TOS can be divided into three subgroups depending on the compressed structure: arterial TOS (aTOS), neurogenic TOS (nTOS), and venous TOS (vTOS). Trauma, repetitive overhead motions, and bony abnormalities are the most common predisposing risk factors, though a number of different etiologies can cause TOS. Symptoms of the upper extremity can include pain, paresthesias, weakness, and atrophy. Patients with vTOS can present with swollen extremities and thrombosis, while patients with aTOS can develop threatened limbs from embolization or thrombosis. Initial treatment for nTOS is conservative, followed by surgical decompression for refractory disease. Patients with vTOS or aTOS who are good surgical candidates are recommended for surgical decompression. The procedure for surgical decompression is a first-rib resection and scalenectomy.