Thoracic Outlet Syndrome in Emergency Medicine Differential Diagnoses

Updated: Aug 25, 2020
  • Author: Andrew K Chang, MD, MS; Chief Editor: Erik D Schraga, MD  more...
  • Print

Diagnostic Considerations

Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome were published in 2016, in part because of inconsistency in the definition and diagnosis of thoracic outlet syndrome (TOS). [6] The committee identified four criteria for TOS, including pain and/or tenderness at the thoracic outlet, signs and symptoms of nerve compression, the absence of other pathology, and a positive scalene muscle injection test. A diagnosis of TOS is warranted when at least three of the criteria are met. [6]

Other conditions to consider in patients with suspected TOS include the following:

  • Cervical spondylitis

  • Mediastinal venous obstruction (eg, Pancoast tumor)

  • Brachial plexitis

  • Fibromyalgia

  • Postural palsy

  • Raynaud disease

  • Trauma

  • Ulnar nerve compression at the elbow

  • Vasculitis

  • Vasospastic disorder

Differential Diagnoses