Neurologic Thoracic Outlet Syndrome
Thoracic outlet syndrome (TOS) is complex clinical entity characterized by various neurovascular signs and symptoms of the upper limb.  It includes several different types of disorders, as follows:
Classic (true) neurologic TOS
Common (disputed) neurologic TOS
Combined neurovascular TOS
TOS can involve various components of the brachial plexus, the blood vessels, or both at different sites between the base of the neck and the axilla.
The arterial form is caused by compression of the subclavian artery, the venous form is caused by compression of the subclavian vein, and the neurologic form is caused by brachial plexus compression. Combined neurovascular TOS is usually traumatic.
Most authors suggest that nonspecific neurologic TOS results from injury to the brachial plexus, by either traction or compression, at some point within the cervicoaxillary canal.
True (classic) neurologic TOS, which is rare, is caused by congenital anomalies. Usually these anomalies include a taut fibrous band or rudimentary cervical rib.
The exact prevalence of TOS is difficult to assess. True neurogenic or vascular TOS is considered rare, but common (nonspecific/disputed) neurogenic TOS is more prevalent.
TOS is more common in women than in men. The sex ratio varies depending on the type of TOS.
The female-to-male ratio in neurologic-type TOS is approximately 3.5:1.
The venous type is more common in males than in females, and the arterial type has no sexual predilection.
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Manish K Singh, MD Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience
Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Headache Society, American Association of Physicians of Indian Origin, American Medical Association, American Society of Regional Anesthesia and Pain Medicine
Disclosure: Nothing to disclose.
Jashvant Patel, MBBS, MS, MD
Jashvant Patel, MBBS, MS, MD is a member of the following medical societies: Alberta Medical Association, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Society of Regional Anesthesia and Pain Medicine, Medical Society of the State of New York
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Robert A Egan, MD NW Neuro-Ophthalmology
Disclosure: Received honoraria from Biogen Idec and Genentech for participation on Advisory Boards.
Jorge E Mendizabal, MD Consulting Staff, Corpus Christi Neurology
Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, National Stroke Association, American Headache Society, Stroke Council of the American Heart Association
Disclosure: Nothing to disclose.
Neurologic Thoracic Outlet Syndrome
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