eMedicine Specialties > Neurology > Headache and Pain

Thoracic Outlet Syndrome: Differential Diagnoses & Workup

Author: Manish K Singh, MD, Assistant Professor, Pain Management, Department of Neurology, Drexel College of Medicine, Hahnemann University hospital
Coauthor(s): Jashvant Patel, MD, Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University
Contributor Information and Disclosures

Updated: Nov 29, 2007

Differential Diagnoses

Ankylosing Spondylitis
Syringomyelia
Cervical Spondylosis: Diagnosis and Management
Torticollis
Median Neuropathy
Traumatic Peripheral Nerve Lesions
Metastatic Disease to the Spine and Related Structures
Ulnar Neuropathy
Radial Mononeuropathy
Reflex Sympathetic Dystrophy

Other Problems to Be Considered

Brachial plexus traction injury
Raynaud disease
Chronic arterial insufficiency
Peripheral nerve entrapment
Peripheral neuropathy
Chronic phlebothrombosis
Somatization disorder
Malingering
Spinal cord disease

Workup

Laboratory Studies

  • A thorough history and physical examination are the most important components in establishing the diagnosis of TOS. Use of radiographic and laboratory tests may improve the diagnostic yield. Various screening tests may be appropriate to exclude other causes of upper extremity pain and paresthesia.

Imaging Studies

  • Radiographs may exhibit bony anomalies.
    • Chest x-ray may demonstrate cervical or first rib, Pancoast tumor clavicle, or other skeletal deformity.
    • Cervical spine radiograph may be helpful in showing a cervical rib, an elongated transverse process, or scoliosis.
  • Color flow duplex scanning can identify interruption of blood flow to the affected extremity.
  • Arteriogram can identify blockage of the artery from thrombi or emboli. It also can detect aneurysms that may be compressing the plexus.
  • Venography (subclavian vein) is confirmatory and remains the criterion standard. This study can demonstrate the site of obstruction or the presence of thrombus.
  • CT scan or MRI is useful to exclude cord lesions and radiculopathy and may exhibit plexus distortion.

Other Tests

  • Electromyography/nerve conduction study may be useful to exclude coexistent abnormalities such as peripheral nerve entrapment or cervical radiculopathy.
  • Sensory evoked potentials are of limited value in making the diagnosis of neurogenic-type TOS and have no established value in vascular-type TOS.

More on Thoracic Outlet Syndrome

Overview: Thoracic Outlet Syndrome
Differential Diagnoses & Workup: Thoracic Outlet Syndrome
Treatment & Medication: Thoracic Outlet Syndrome
Follow-up: Thoracic Outlet Syndrome
References
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Further Reading

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Keywords

TOS, thoracic outlet syndrome, brachial plexus, neurologic TOS, vascular TOS, compression of the subclavian artery, compression of the subclavian vein, brachial plexus compression, congenital anomaly, arterial TOS, venous TOS, combined neurovascular TOS

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Contributor Information and Disclosures

Author

Manish K Singh, MD, Assistant Professor, Pain Management, Department of Neurology, Drexel College of Medicine, Hahnemann University hospital
Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Association of Physicians of Indian Origin, American Headache Society, American Medical Association, and American Society of Regional Anesthesia and Pain Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jashvant Patel, MD, Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University
Jashvant Patel, MD is a member of the following medical societies: Alberta Medical Association, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Society of Regional Anesthesia and Pain Medicine, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Medical Editor

Jorge E Mendizabal, MD, Consulting Staff, Corpus Christi Neurology
Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, National Stroke Association, and Stroke Council of the American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James H Halsey, MD, Professor, Department of Neurology, University of Alabama Medical Center
James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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