77th ASSH Annual Meeting - Back to Basics: Practice and Education-IC22: When You Hear Hoof Beats, Think of Horses, but Don't Forget the Zebras: An Evidence-Based Approach to Uncommon Compression Neuropathies of the Upper Extremity (AM22)

IC22: When You Hear Hoof Beats, Think of Horses, but Don't Forget the Zebras: An Evidence-Based Approach to Uncommon Compression Neuropathies of the Upper Extremity (AM22)

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Video Summary

There is still some controversy in the diagnosis and treatment of thoracic outlet syndrome (TOS). TOS is a group of disorders characterized by compression of arteries, veins, or nerves between the clavicle and first rib. About 90% of cases are neurogenic TOS, which involve compression of the nerves. The diagnosis of TOS can be challenging, and it is typically based on physical examination findings such as the Edson's test, the Roux's test, and the upper limb tension test. Electrodiagnostic studies and imaging can also be used to confirm the diagnosis. Treatment options for TOS include non-surgical approaches such as physical therapy and conservative management, as well as surgical interventions. There is limited high-quality evidence to guide treatment decisions, but generally, surgery is considered effective for most patients. The choice of surgical approach, such as supraclavicular or transaxillary, and the need for first rib resection depends on the individual patient and their specific symptoms. Recent research suggests that rib-sparing scalenectomy is an effective treatment option for neurogenic TOS, and it may result in fewer complications compared to first rib resection. However, further research is needed to better understand the efficacy and optimal management of TOS.

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Session Tracks Nerve

Speaker Aaron M. Freilich, MD

Speaker Clifford T. Pereira, MD, FACS, FRCS(Eng)

Speaker Harvey W. Chim, MD

Speaker Joy V. Sharma, MD

Speaker Kevin Chan, MD, FRCSC

Keywords

thoracic outlet syndrome

compression

neurogenic TOS

physical examination

surgical interventions

first rib resection

rib-sparing scalenectomy

complications

research

efficacy