Abstract：
Thoracic outlet syndrome (TOS) is a rare condition (1-3 per 100,000) caused by neurovascular compression at the thoracic outlet and presents with arm pain and swelling, arm fatigue, paresthesias, weakness and discoloration of the hand. TOS can be classified as neurogenic, arterial, or venous based on the compressed structure(s). Patients develop TOS secondary to congenital abnormalities such as cervical ribs or fibrous bands originating from a cervical rib leading to an objectively verifiable form of TOS. However, the diagnosis of TOS is often made in the presence of symptoms with physical exam findings (disputed TOS). TOS is not a diagnosis of exclusion and there should be evidence for a physical anomaly that can be corrected. In patients with an identifiable narrowing of the thoracic outlet and/or symptoms with a high probability of thoracic outlet neurovascular compression, diagnosis of TOS can be established through history, a physical exam maneuvers, and imaging. Neck trauma or repeated work stress can cause scalene muscle scaring or dislodging of a congenital cervical rib which can compress the brachial plexus. Nonsurgical treatment includes anti-inflammatory medication, weight loss, physical therapy/strengthening exercises, and botulinum toxin injections. The most common surgical treatments include brachial plexus decompression, neurolysis, and scalenotomy with or without first rib resection. Patients undergoing surgical treatment for TOS should be seen postoperatively to begin passive/assisted mobilization of the shoulder. By eight weeks postoperatively, patients can begin resistance strength training. Surgical treatment complications include injury to the subclavian vessels potentially leading to exsanguination and death, brachial plexus injury, hemothorax, and pneumothorax. In this review, we outline the diagnostic tests and treatment options for TOS to better guide clinicians in recognizing and treating vascular TOS and objectively verifiable forms of neurogenic TOS.
摘要：
胸廓出口综合征（TOS）是一种罕见的疾病（每100,000人中有1-3人），由胸廓出口处的神经血管压迫引起，并表现为手臂疼痛和肿胀。手臂疲劳,感觉异常,手的虚弱和变色。TOS可以归类为神经源性，动脉，或基于压缩结构的静脉。患者发生继发于先天性异常的TOS，例如颈肋骨或源自颈肋骨的纤维带，从而导致客观可验证的TOS形式。然而,TOS的诊断通常是在有体检结果的症状(有争议的TOS)的情况下进行的.TOS不是排除诊断，应该有可以纠正的物理异常的证据。对于可识别的胸腔出口狭窄和/或有高概率的胸腔出口神经血管压迫症状的患者，TOS的诊断可以通过病史来确定，体检演习，和成像。颈部外伤或反复的工作压力会导致先天性颈肋骨的斜角肌惊吓或移位，从而压迫臂丛神经。非手术治疗包括抗炎药，减肥,物理治疗/加强锻炼，注射肉毒杆菌毒素.最常见的手术治疗包括臂丛神经减压术，神经溶解,和有或没有第一肋骨切除的斜角切开术。接受TOS手术治疗的患者应在术后开始被动/辅助动员肩部。术后8周,患者可以开始阻力力量训练。手术治疗并发症包括锁骨下血管损伤，可能导致失血和死亡，臂丛神经损伤,血胸,和气胸.在这次审查中,我们概述了TOS的诊断测试和治疗方案,以更好地指导临床医生识别和治疗血管性TOS和可客观验证的神经源性TOS.
