Contemporary management of thoracic outlet syndrome

Benjamin S. Brooke, Julie A. Freischlag

Research output: Contribution to journalArticle

Abstract

PURPOSE OF REVIEW: The diagnosis and management of thoracic outlet syndrome (TOS) has been surrounded by controversy since this disorder was first recognized. Recent evidence from observational studies has helped us better understand the pathophysiology of different TOS subtypes and guide clinical decision making for this disorder. RECENT FINDINGS: The identification of anatomic anomalies involved with the cause of different TOS subtypes has been made easier by contemporary diagnostic techniques. This includes the injection of neuromuscular blocking agents into anterior scalene muscles to help confirm the diagnosis of neurogenic TOS. Surgical intervention by means of first rib resection and anterior scalenectomy is an effective treatment for patients diagnosed with neurogenic and venous TOS, resulting in a significant increase in quality-of-life measures for the majority of patients. Patients with acute and chronic venous TOS should be maintained on anticoagulation during the perioperative period and may not need thrombolysis prior to surgery. Finally, patients with arterial TOS should undergo cervical or first rib resection with or without arterial reconstruction to alleviate and prevent recurrence of symptoms. SUMMARY: The management of TOS requires a multidisciplinary approach with specific treatment algorithms for each TOS subtype. Appropriately selected patients with all different types of TOS may benefit from surgical intervention.

Original languageEnglish (US)
Pages (from-to)535-540
Number of pages6
JournalCurrent Opinion in Cardiology
Volume25
Issue number6
DOIs
StatePublished - Nov 2010

Fingerprint

Thoracic Outlet Syndrome
Ribs
Neuromuscular Blocking Agents
Perioperative Period
Observational Studies

Keywords

  • first rib resection and scalenectomy
  • Paget-von Schrö etter syndrome
  • thoracic outlet syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Contemporary management of thoracic outlet syndrome. / Brooke, Benjamin S.; Freischlag, Julie A.

In: Current Opinion in Cardiology, Vol. 25, No. 6, 11.2010, p. 535-540.

Research output: Contribution to journalArticle

Brooke, Benjamin S. ; Freischlag, Julie A. / Contemporary management of thoracic outlet syndrome. In: Current Opinion in Cardiology. 2010 ; Vol. 25, No. 6. pp. 535-540.
@article{cc3afaddc7434c5ea12860182a285134,
title = "Contemporary management of thoracic outlet syndrome",
abstract = "PURPOSE OF REVIEW: The diagnosis and management of thoracic outlet syndrome (TOS) has been surrounded by controversy since this disorder was first recognized. Recent evidence from observational studies has helped us better understand the pathophysiology of different TOS subtypes and guide clinical decision making for this disorder. RECENT FINDINGS: The identification of anatomic anomalies involved with the cause of different TOS subtypes has been made easier by contemporary diagnostic techniques. This includes the injection of neuromuscular blocking agents into anterior scalene muscles to help confirm the diagnosis of neurogenic TOS. Surgical intervention by means of first rib resection and anterior scalenectomy is an effective treatment for patients diagnosed with neurogenic and venous TOS, resulting in a significant increase in quality-of-life measures for the majority of patients. Patients with acute and chronic venous TOS should be maintained on anticoagulation during the perioperative period and may not need thrombolysis prior to surgery. Finally, patients with arterial TOS should undergo cervical or first rib resection with or without arterial reconstruction to alleviate and prevent recurrence of symptoms. SUMMARY: The management of TOS requires a multidisciplinary approach with specific treatment algorithms for each TOS subtype. Appropriately selected patients with all different types of TOS may benefit from surgical intervention.",
keywords = "first rib resection and scalenectomy, Paget-von Schr{\"o} etter syndrome, thoracic outlet syndrome",
author = "Brooke, {Benjamin S.} and Freischlag, {Julie A.}",
year = "2010",
month = "11",
doi = "10.1097/HCO.0b013e32833f028e",
language = "English (US)",
volume = "25",
pages = "535--540",
journal = "Current Opinion in Cardiology",
issn = "0268-4705",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Contemporary management of thoracic outlet syndrome

AU - Brooke, Benjamin S.

AU - Freischlag, Julie A.

PY - 2010/11

Y1 - 2010/11

N2 - PURPOSE OF REVIEW: The diagnosis and management of thoracic outlet syndrome (TOS) has been surrounded by controversy since this disorder was first recognized. Recent evidence from observational studies has helped us better understand the pathophysiology of different TOS subtypes and guide clinical decision making for this disorder. RECENT FINDINGS: The identification of anatomic anomalies involved with the cause of different TOS subtypes has been made easier by contemporary diagnostic techniques. This includes the injection of neuromuscular blocking agents into anterior scalene muscles to help confirm the diagnosis of neurogenic TOS. Surgical intervention by means of first rib resection and anterior scalenectomy is an effective treatment for patients diagnosed with neurogenic and venous TOS, resulting in a significant increase in quality-of-life measures for the majority of patients. Patients with acute and chronic venous TOS should be maintained on anticoagulation during the perioperative period and may not need thrombolysis prior to surgery. Finally, patients with arterial TOS should undergo cervical or first rib resection with or without arterial reconstruction to alleviate and prevent recurrence of symptoms. SUMMARY: The management of TOS requires a multidisciplinary approach with specific treatment algorithms for each TOS subtype. Appropriately selected patients with all different types of TOS may benefit from surgical intervention.

AB - PURPOSE OF REVIEW: The diagnosis and management of thoracic outlet syndrome (TOS) has been surrounded by controversy since this disorder was first recognized. Recent evidence from observational studies has helped us better understand the pathophysiology of different TOS subtypes and guide clinical decision making for this disorder. RECENT FINDINGS: The identification of anatomic anomalies involved with the cause of different TOS subtypes has been made easier by contemporary diagnostic techniques. This includes the injection of neuromuscular blocking agents into anterior scalene muscles to help confirm the diagnosis of neurogenic TOS. Surgical intervention by means of first rib resection and anterior scalenectomy is an effective treatment for patients diagnosed with neurogenic and venous TOS, resulting in a significant increase in quality-of-life measures for the majority of patients. Patients with acute and chronic venous TOS should be maintained on anticoagulation during the perioperative period and may not need thrombolysis prior to surgery. Finally, patients with arterial TOS should undergo cervical or first rib resection with or without arterial reconstruction to alleviate and prevent recurrence of symptoms. SUMMARY: The management of TOS requires a multidisciplinary approach with specific treatment algorithms for each TOS subtype. Appropriately selected patients with all different types of TOS may benefit from surgical intervention.

KW - first rib resection and scalenectomy

KW - Paget-von Schrö etter syndrome

KW - thoracic outlet syndrome

UR - http://www.scopus.com/inward/record.url?scp=78049258803&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78049258803&partnerID=8YFLogxK

U2 - 10.1097/HCO.0b013e32833f028e

DO - 10.1097/HCO.0b013e32833f028e

M3 - Article

C2 - 20838336

AN - SCOPUS:78049258803

VL - 25

SP - 535

EP - 540

JO - Current Opinion in Cardiology

JF - Current Opinion in Cardiology

SN - 0268-4705

IS - 6

ER -