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Thoracic outlet syndrome (TOS) represents a clinical condition caused by compression of the neurovascular structures that cross the thoracic outlet. TOS can be classified in: 1) neurogenic TOS (NTOS), 2) venous TOS (VTOS), 3) arterial TOS (ATOS). Many different causes can determine the syndrome: congenital malformations, traumas, and functional impairments.This manuscript reviews how the congenital malformations play an important role in adult age; however, TOS also affects patients of all ages.Radiological imaging like X-ray (radiography), magnetic resonance and computed tomography can provide useful information to assess TOS causes and decide a potential surgery. 79% of the patients included in the first two stages of nerve, artery, vein (NAV) staging experienced excellent results with kinesiotherapy; whereas patients included in the third and fourth stage of NAV staging were subject to surgery.The treatment of acute forms of TOS involves thrombolysis and anticoagulant therapy; surgery is appropriate for true NTOS, vascular TOS and in some cases when conservative treatment fails.

Objectives: Thoracic outlet syndrome (TOS) is an upper extremity disorder resulting from compression of brachial plexus structures and subclavian vessels within thoracic outlet region at any of the three primary sites- interscalene triangle, costoclavicular space and retro-pectoralis minor space. This study focused on detailed anatomic exploration and measurement of normal anatomic variability within interscalene triangle and costoclavicular space. Material and Method: We examined 49 cadavers (22 male and 27 female) and dissected both sides to explore and examine 98 dissected areas. We measured the base width, height, angle within interscalene triangle and the vertical distance within costoclavicular space. We also calculated the area of interscalene triangle. Results: The mean values of base width, height, interscalene angulation of interscalene triangle and height of costoclavular space was 10.18±4.31 mm, 45.19±0.07mm, 10.85±0.06 degrees and 10.22±0.07 mm respectively. The mean area of interscalene triangle was 214.82±5.22sqmm. Conclusion: We have found clinically significant differences between the interscalene and costiclavicular space vertical heights; the height of costoclavicular space was clinically significantly lower than the interscalene space (p< 0.001). No clinical significant difference was found between male and female measurements. These ranges of dataset could be useful for planning treatment approaches in TOS.

Thoracic outlet syndrome refers to a multitude of signs and symptoms in the upper limb resulting from compression of the neurovascular bundle within the interscalene triangle. It is a complex clinical entity to diagnose on imaging, given its transient and postural nature, which is not often appreciable on nondynamic imaging. Here we describe an uncommon presentation of thoracic outlet syndrome resulting from an extrapleural lipoma and outline its multimodality-based investigation and management.

Objective Thoracic outlet syndrome classically results from constrictions in 1 or more of 3 specific anatomical locations: the interscalene triangle, costoclavicular space, and coracopectoral tunnel. Magnetic resonance and computed tomographic imaging studies suggest that, of the 3 potential locations for constriction, the costoclavicular space is the most susceptible to compression. This study of human cadavers aims to expand on the descriptive anatomy of the interscalene triangle and associated costoclavicular space. Methods The interscalene angle, interscalene triangle base, and costoclavicular space were measured on 120 sides of embalmed human cadavers. Linear distances and angles were measured using a caliper and protractor, respectively. The data were analyzed by calculating the mean, range, and standard deviation. Results The range for the interscalene base was 0 to 21.0 mm with a mean of 10.7 mm. For the interscalene angle, the range was 4° to 22° with a mean of 11.3°. Measurements for the costoclavicular space ranged from 6 to 30.9 mm with a mean of 13.5 mm. Conclusions No significant differences were observed between left and right interscalene triangles or costoclavicular spaces; furthermore, there were no differences between the sexes concerning these 2 locations.

Of the many clinical entities involving the neck region, one of the most intriguing is thoracic outlet syndrome (TOS). TOS is an array of disorders that involves injury to the neurovascular structures in the cervicobrachial region. A classification system based on etiology, symptoms, clinical presentation, and anatomy is supported by most physicians. The first type of TOS is vascular, involving compression of either the subclavian artery or vein. The second type is true neurogenic TOS, which involves injury to the brachial plexus. Finally, the third and most controversial type is referred to as disputed neurogenic TOS. This article aims to provide the reader some understanding of the pathophysiology, workup, and treatment of this fascinating clinical entity.

TOS is caused by compression of brachial plexus or subclavian vessels in their passage from cervical area towards axilla and proximal arm either at interscalene triangle, costoclavicular triangle o...

The subclavian artery is a major constituent of the blood circulatory system. Its position in the root of the neck and its course through the interscalene triangle are significant. Its branches supply divers areas in the body from the brain to the thorax. This case report describes an unusual range of anatomical variations of the course of the left subclavian artery, the origin, and absence of some of its branches and the concomitant abnormal course of the phrenic nerve. Clinical syndromes related to certain variations are reviewed. Clin. Anat. 18:370–372, 2005. © 2005 Wiley-Liss, Inc.

The thoracic outlet region contains three important structures: the brachial plexus, the subclavian artery, and the subclavian vein. As they travel from the upper mediastinum to the upper extremity, these structures run through three important spaces: the interscalene triangle, the costoclavicular space, and the subpectoral space. Compression can occur in any of these three spaces because of structural anomalies or trauma.

The predisposing anatomic alterations or features of thoracic outlet syndrome have been tallied to better define this difficult and inchoate issue. In the last 34 supraclavicular operations involving 33 patients (for a total operative experience of 128 procedures), we have found the anterior insertion of the middle scalene muscle to be present in 48 percent of our patients. This insertion, forward on the first rib, closes an already small interscalene triangle, so that the posteriorly placed brachial plexus is entrapped or irritated by the anterior edge of this muscle, which may be very sharp and firm. In addition, 10 percent of our patients had a middle scalene band intimately associated with the middle scalene muscle, oftentimes inseparable, for a 58 percent incidence of middle scalene involvement in the thoracic outlet syndrome. With data such as those presented herein, a more simplified operation than the heretofore popular all-out attack on the first rib may well be in the offing.