Search

Context Thoracic outlet syndrome (TOS) symptoms are prevalent and often confused with other diagnoses. A PubMed search was undertaken to present a comprehensive article addressing the presentation and treatment for TOS. Objectives This article summarizes what is currently published about TOS, its etiologies, common objective findings, and nonsurgical treatment options. Methods The PubMed database was conducted for the range of May 2020 to September 2021 utilizing TOS-related Medical Subject Headings (MeSH) terms. A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) systematic literature review was conducted to identify the most common etiologies, the most objective findings, and the most effective nonsurgical treatment options for TOS. Results The search identified 1,188 articles. The automated merge feature removed duplicate articles. The remaining 1,078 citations were manually reviewed, with articles published prior to 2010 removed (n=771). Of the remaining 307 articles, duplicate citations not removed by automated means were removed manually (n=3). The other exclusion criteria included: non-English language (n=21); no abstracts available (n=56); and case reports of TOS occurring from complications of fractures, medical or surgical procedures, novel surgical approaches, or abnormal anatomy (n=42). Articles over 5 years old pertaining to therapeutic intervention (mostly surgical) were removed (n=18). Articles pertaining specifically to osteopathic manipulative treatment (OMT) were sparse and all were utilized (n=6). A total of 167 articles remained. The authors added a total of 20 articles that fell outside of the search criteria, as they considered them to be historic in nature with regards to TOS (n=8), were related specifically to OMT (n=4), or were considered sentinel articles relating to specific therapeutic interventions (n=8). A total of 187 articles were utilized in the final preparation of this manuscript. A final search was conducted prior to submission for publication to check for updated articles. Symptoms of hemicranial and/or upper-extremity pain and paresthesias should lead a physician to evaluate for musculoskeletal etiologies that may be contributing to the compression of the brachial plexus. The best initial provocative test to screen for TOS is the upper limb tension test (ULTT) because a negative test suggests against brachial plexus compression. A positive ULTT should be followed up with an elevated arm stress test (EAST) to further support the diagnosis. If TOS is suspected, additional diagnostic testing such as ultrasound, electromyography (EMG), or magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) might be utilized to further distinguish the vascular or neurological etiologies of the symptoms. Initial treatment for neurogenic TOS (nTOS) is often conservative. Data are limited, therefore there is no conclusive evidence that any one treatment method or combination is more effective. Surgery in nTOS is considered for refractory cases only. Anticoagulation and surgical decompression remain the treatment of choice for vascular versions of TOS. Conclusions The most common form of TOS is neurogenic. The most common symptoms are pain and paresthesias of the head, neck, and upper extremities. Diagnosis of nTOS is clinical, and the best screening test is the ULTT. There is no conclusive evidence that any one treatment method is more effective for nTOS, given limitations in the published data. Surgical decompression remains the treatment of choice for vascular forms of TOS.

The German polarimetric C-band weather radar Poldirad (Polarization Diversity Radar) was deployed for the international field campaign EUREC4A (Elucidating the role of clouds–circulation coupling in climate) on the island of Barbados where it was operated from February until August 2020. Focus of the installation was monitoring clouds and precipitation in the trade wind region east of Barbados. Different scanning modes were used with a temporal sequence of 5 min and a maximum range of 375 km. In addition to built-in quality control performed by the radar signal processor, it was found that the copoloar correlation coefficient ρHV can be used to remove contamination of radar products by sea clutter. Radar images were available in real time for all campaign participants and aboard research aircraft. Examples of mesoscale precipitation patterns, rain rate accumulation, diurnal cycle, and vertical distribution are given to show the potential of the radar measurements for further studies on the life cycle of precipitating shallow cumulus clouds and other related aspects. Poldirad data from the EUREC4A campaign are available on the EUREC4A AERIS database: https://doi.org/10.25326/218 (Hagen et al., 2021a) for raw data and https://doi.org/10.25326/217 (Hagen et al., 2021b) for gridded data.

To advance the understanding of the interplay among clouds, convection, and circulation, and its role in climate change, the Elucidating the role of clouds–circulation coupling in climate campaign (EUREC4A) and Atlantic Tradewind Ocean–Atmosphere Mesoscale Interaction Campaign (ATOMIC) collected measurements in the western tropical Atlantic during January and February 2020. Upper-air radiosondes were launched regularly (usually 4-hourly) from a network consisting of the Barbados Cloud Observatory (BCO) and four ships within 6–16∘ N, 51–60∘ W. From 8 January to 19 February, a total of 811 radiosondes measured wind, temperature, and relative humidity. In addition to the ascent, the descent was recorded for 82 % of the soundings. The soundings sampled changes in atmospheric pressure, winds, lifting condensation level, boundary layer depth, and vertical distribution of moisture associated with different ocean surface conditions, synoptic variability, and mesoscale convective organization. Raw (Level 0), quality-controlled 1 s (Level 1), and vertically gridded (Level 2) data in NetCDF format (Stephan et al., 2020) are available to the public at AERIS (https://doi.org/10.25326/137). The methods of data collection and post-processing for the radiosonde data set are described here.

The 2020 Elucidating the role of clouds-circulation coupling in climate - Ocean-Atmosphere (EUREC4A-OA) and Atlantic Tradewind Ocean-Atmosphere Mesoscale Interaction Campaign (ATOMIC) campaigns sought to improve the knowledge of the interaction between clouds, convection and circulation and their function in our changing climate. The campaign consisted of numerous research technologies, some of which are relatively novel to the scientific community. In this study we used a saildrone uncrewed surface vehicle to validate satellite and modelled sea surface salinity (SSS) products in the Western Tropical Atlantic. These products include the Soil Moisture Active Passive (SMAP) Jet Propulsion Laboratory (JPL), SMAP Remote Sensing Systems (RSS), and Hybrid Coordinate Ocean Model (HYCOM). In addition to the validation, we investigated a fresh tongue south east of Barbados. The saildrones accurately depicted the salinity conditions and all satellite and modelled products performed well in areas that lacked small-scale salinity variability. However, SMAP RSS 70 km outperformed its counterparts in areas with small submesoscale irregularities while RSS 40 km was better at identifying small irregularities in salinity such as a fresh tongue. These results will allow researchers to make informed decisions regarding the most ideal product for their application and aid in the improvement of mesoscale and submesoscale SSS products, which can lead to the refinement of numerical weather prediction (NWP) and climate models.

The German polarimetric C-band weather radar Poldirad (Polarization Diversity Radar) was deployed for the international field campaign EUREC4A (ElUcidating the RolE of Cloud-Circulation Coupling in ClimAte) on the island of Barbados. Poldirad was operated on Barbados from February until August 2020. Focus of the installation was monitoring clouds and precipitation in the trade wind region east of Barbados. Different scanning modes were used with a temporal sequence of 5 minutes and a maximum range of 375 km. In addition to built-in quality control performed by the radar signal processor, it was found that the copoloar correlation coefficient ρHV can be used to remove contamination of radar products by sea clutter. Radar images were available in real-time for all campaign participants and onboard of research aircraft. Examples of mesoscale precipitation patterns, rain rate accumulation, diurnal cycle, and vertical distribution are given to show the potential of the radar measurements for further studies on the life cycle of precipitating shallow cumulus clouds and other related aspects. Poldirad data from the EUREC4A campaign are available on the EUREC4A AERIS database: https://doi.org/10.25326/218 (Hagen et al., 2021a) for raw data and https://doi.org/10.25326/217 (Hagen et al., 2021b) for gridded data.

The science guiding the EUREC4A campaign and its measurements is presented. EUREC4A comprised roughly 5 weeks of measurements in the downstream winter trades of the North Atlantic – eastward and southeastward of Barbados. Through its ability to characterize processes operating across a wide range of scales, EUREC4A marked a turning point in our ability to observationally study factors influencing clouds in the trades, how they will respond to warming, and their link to other components of the earth system, such as upper-ocean processes or the life cycle of particulate matter. This characterization was made possible by thousands (2500) of sondes distributed to measure circulations on meso- (200 km) and larger (500 km) scales, roughly 400 h of flight time by four heavily instrumented research aircraft; four global-class research vessels; an advanced ground-based cloud observatory; scores of autonomous observing platforms operating in the upper ocean (nearly 10 000 profiles), lower atmosphere (continuous profiling), and along the air–sea interface; a network of water stable isotopologue measurements; targeted tasking of satellite remote sensing; and modeling with a new generation of weather and climate models. In addition to providing an outline of the novel measurements and their composition into a unified and coordinated campaign, the six distinct scientific facets that EUREC4A explored – from North Brazil Current rings to turbulence-induced clustering of cloud droplets and its influence on warm-rain formation – are presented along with an overview of EUREC4A's outreach activities, environmental impact, and guidelines for scientific practice. Track data for all platforms are standardized and accessible at https://doi.org/10.25326/165 (Stevens, 2021), and a film documenting the campaign is provided as a video supplement.