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Abstract
Thoracic outlet syndrome (TOS) is one of the most controversial subjects in medicine. Controversy surrounds this disease in its aetiology, diagnosis, treatment and even its name.
The name TOS was designated by Peet. He used this term to group under one name entities that are anatomically and clinically different by representing a single common element, namely the compression of the neurovascular structures of the upper extremity during their passage through the thoracic outlet region.
Congenital or acquired bony abnormalities, fibromuscular aberrations and faulty posture may be responsible for the compression. Certain movements may also increase compression.
Commonest sites for neurovascular compression within the thoracic outlet region are the interscalene triangle, the costoclavicular space and the retropectoralis minor space.
TOS is also a challenge to diagnose. The first step towards diagnosis of TOS is keeping in mind the existence of TOS.
The wide variability of symptoms and lack of a single, accurate test that can confirm the diagnosis make TOS difficult to identify. It has been suggested that TOS may be the most frequently overlooked and misdiagnosed syndrome, or even overdiagnosed
Two types of TOS could be identified, namely neurogenic and vascular TOS, with the neurogenic type is the most common and responsible for about 95% of TOS cases.
The diagnosis of neurogenic TOS is relatively straightforward in the patient with pain and sensory disturbance predominantly in the ulnar forearm and hand, aggravated by use of the affected limb; associated with weakness and wasting of the small hand muscles particularly in the thenar eminence; a radiographic cervical rib; and neurophysiological studies confirming chronic postganglionic axonal loss, and excluding focal mononeuropathy