Epidemiology, diagnosis and treatment of thoracic outlet syndrome. A systematic review.

Thoracic Outlet Syndrome (TOS) refers to the compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle leading to a wide range of signs and symptoms. Moreover, symptomatic overlap with other conditions makes it very difficult to confi- dently diagnose TOS and subsequently to treat it. This arti- cle presents a systematic analysis of the most recent scientific literature on epidemiology, the different etiologies of TOS, diagnostic procedures and innovative treatments. PubMed and ScienceDirect databases were searched for articles us- ing the terms: “anatomy of thoracic outlet”, “thoracic outlet syndrome”, “arterial outlet syndrome”, “venous outlet syn- drome”, “nervous and disputed outlet syndrome”, “compres- sion, management of thoracic outlet syndrome”. All poten- tially eligible studies were subsequently evaluated in detail by authors considering the full text. Reference lists of retrieved articles were also searched for relevant publications. The initial database searches yielded 2301 studies from PubMed, and 1786 from ScienceDirect. We evaluated eligible 256 full text articles. The anatomy of thoracic outlet, the etiopatho- genesis of different forms of TOS, the current procedures of diagnosis of each type of TOS found in literature, the de- scription of the recent indications to the medical or surgical therapies in patients with TOS are here prsented. Modern studies indicate that a multidisciplinary comprehensive ap- proach to TOS improves early and long-term outcomes. In fact, the treatment of TOS involves a combination of good clinical skills, multidisciplinary work, careful imaging, me- ticulous surgery, risk manag