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 radiograph may demonstrate cervical or first rib, Pancoast tumor, 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.

CT angiography can identify stenosis, or 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 if intervention is planned. 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, evaluate soft tissue structures and may exhibit plexus distortion.

Other Tests

Electromyography/nerve conduction study (EMG/NCS) may be useful to exclude coexistent abnormalities such as peripheral nerve entrapment or cervical radiculopathy and is more useful in the diagnosis of true neurogenic TOS. In true neurogenic TOS, EMG/NCS of patients will show reduced amplitude in the medial antebrachial and ulnar sensory responses and reduced amplitude in median and ulnar (median more so than ulnar) motor responses, with a normal median sensory response.^{[8, 9]}

Sensory evoked potentials are of limited value in making the diagnosis of neurogenic-type TOS and have no established value in vascular-type TOS.

Treatment & Management

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Author

Joy Chan, MD Resident Physician, Department of Neurology, University of California, Los Angeles, David Geffen School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Nasheed I Jamal, MD Assistant Clinical Professor, Department of Neurology, Director, UCLA Neuromuscular Medicine Fellowship Program, University of California, Los Angeles, David Geffen School of Medicine; Acting Chief, Neurology Service, Associate Chief of Neurology, Los Angeles Ambulatory Care Center, Director, Multidisciplinary Clinic, Co-Director, Tele-Polyneuropathy Clinic, Department of Neurology, VA Greater Los Angeles Healthcare System

Nasheed I Jamal, MD is a member of the following medical societies: American Academy of Neurology, American Association for the Advancement of Science

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Robert A Egan, MD NW Neuro-Ophthalmology

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, Oregon Medical Association

Disclosure: Received honoraria from Biogen Idec and Genentech for participation on Advisory Boards.

Additional Contributors

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, National Stroke Association, American Headache Society, Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

Manish K Singh, MD Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience

Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Headache Society, American Association of Physicians of Indian Origin, American Medical Association, American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Jashvant Patel, MBBS, MS, MD

Jashvant Patel, MBBS, MS, 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, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Sections Neurologic Thoracic Outlet Syndrome
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
References

Neurologic Thoracic Outlet Syndrome Workup

Laboratory Studies

Imaging Studies

Other Tests

References

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