The treatment of neurogenic thoracic outlet syndrome, abbreviated as nTOS has been hampered by inconsistent definitions and diagnosis which leads to uncertainty regarding treatment options and a lack of consistent outcome measures Illig et al. (2016) of the Society for Vascular Surgery published reporting standards for TOS with the primary aim to provide a clear and consistent understanding and definition of what constitutes a diagnosis of nTOS. Following these criteria, nTOS should be defined by the presence of three of the following four:
LOCAL FINDINGS: a.History: Symptoms consistent with irritation or inflammation at the site of compression either at the scalene triangle or the pectoralis insertion along with symptoms due to referred pain in the areas near the thoracic outlet. Patients may complain of pain in the chest wall, axilla, upper back, shoulder, trapezius region, neck, or head (including headache). b.Examination: Pain on palpation of the affected area as above
PERIPHERAL FINDINGS: a.History: Arm or hand symptoms consistent with central nerve compression. Such symptoms can include numbness, pain, paresthesias, vasomotor changes, and weakness (with muscle wasting in extreme cases). These peripheral symptoms are often exacerbated by maneuvers that either narrow the thoracic outlet (lifting the arms overhead) or stretch the brachial plexus (dangling; often driving or walking/running). b. Examination: Palpation of the affected area (scalene triangle or pectoralis minor insertion site) often reproduces the peripheral symptoms. Peripheral symptoms are often produced or worsened by provocative maneuvers that are believed to narrow the scalene triangle like the Roos Test also known as the elevated arm stress test or to stretch the brachial plexus like in the ULTT1
ABSENCE of other reasonably likely diagnoses like cervical disk disease, shoulder disease, carpal tunnel syndrome, chronic regional pain syndrome, brachial neuritis that might explain the majority of symptoms
4. In those who undergo it, the response to a properly performed TEST INJECTION is positive.
In addition, most patients have prolonged symptoms for more than 6 months, deteriorate over time, and have a history of trauma, although these factors are not required for diagnosis.
It has to be said that the subjective nature of many of these diagnostic findings contributes to the controversy surrounding the validity of the diagnosis of nTOS.
What customers have to say about the Assessment E-Book
The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!
The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
Great work, guys
The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!
The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.
The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
Congrats guys you’ve done an incredible job.
I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
In one word: amazing. Keep going guys ! Best wishes from france.
This content is for members
Create your free account to gain access to this exclusive content and more!
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.