Thoracic Outlet Syndrome

Objective: Thoracic outlet syndrome (TOS) is one of the most controversial clinical entities in medicine. We provide a review of this disorder, including clinical presentations, surgical anatomy, treatment options, and outcomes.Methods:Retrospective analysis the age .evidence of diagnosis, therapy method and follow up of 15 cases from 1992-2to 2006-2 in our department. Results: In 9 patients accepted transaxillary approach with first rib resection , 7 of the case are well recover without complication, 1 went with pneumothorax, 1 went with venous thrombosis . In 3 patient accepted supraclavicular exposure and are well recover without complication. In 2 patients accepted conservative treatment including exercise programs and physical therapy ,1 patient recovered .another patient lost follow up. The last one patient refused any treatment .Conclusion: A careful and detailed medical history and physical examination are the most important diagnostic tools for proper identification of TOS. Electromyography, nerve conduction studies, and imaging of the cervical spine and the chest also can provide helpful information regarding diagnosis. Clinical management usually starts with conservative treatment including exercise programs and physical therapy;when these therapies fail, patients are considered for surgery. Two of the most commonly used surgical approaches are the supraclavicularexposure and the transaxillary approach with first rib resection. On occasion, these approaches may be combined or, alternatively, posterior subscapular exposure may be used in selected patients. TOS is perhaps the most difficult-to-treat entrapment neuropathy encountered by doctor. Surgical intervention is indicated for patients with vascular and true neurogenic TOS and in those with the nonspecific or disputed type of TOS, in whom nonoperative treatment fails. With careful patient selection, operative intervention usually can yield satisfactory results.