THORACIC OUTLET SYNDROME

Table of contents (97 chapter)
1.A Brief History of the Thoracic Outlet Compression Syndromes
2.Embryology of the Thoracic Outlet
3.Anatomy of the Thoracic Outlet and Related Structures
4.Clinical Incidence and Prevalence: Basic Data on the Current Scope of the Problem
5.NTOS for the Primary Care Team: When to Consider the Diagnosis?
6.Anatomy and Pathophysiology of NTOS
7.Clinical Presentation of Patients with NTOS
8.Differential Diagnosis in Patients with Possible NTOS
9.NTOS from the Physical Therapists’ Point of View
10.The Gilliatt-Sumner Hand
11.NTOS in the Pediatric Age Group
12.NTOS in the Competitive Athlete
13.Cervical Ribs and NTOS
14.NTOS and Repetitive Trauma Disorders
15.Pectoralis Minor Syndrome
16.Double Crush Syndrome
17.Ergonomic and Postural Issues in NTOS
18.Radiographic Imaging in Diagnosis and Assessment of NTOS
19.Electrophysiological Assessment and Nerve Function in NTOS
20.Scalene Test Blocks and Interventional Techniques in Patients with TOS
21.Development of Consensus-Based Diagnostic Criteria for NTOS
22.Pathways of Care and Treatment Options for Patients with NTOS
23.Physical Therapy for NTOS
24.Occupational Therapy Treatment for NTOS
25.Chiropractic Treatment of NTOS
26.Complementary and Alternative Medicine and NTOS
27.Complex Regional Pain Syndrome and NTOS
28.Surgical Techniques: Operative Decompression Using the Transaxillary Approach for NTOS
29.Surgical Techniques: Operative Decompression Using the Supraclavicular Approach for NTOS
30.Surgical Techniques: Pectoralis Minor Tenotomy for NTOS
31.Surgical Techniques: Cervical Sympathectomy in the Treatment of CRPS/RSD
32.Surgical Techniques: Posterior Approach for Reoperative NTOS
33.NTOS: Postoperative Care
34.Passive and Active Rehabilitation After First Rib Resection
35.Pain Management in Neurogenic Thoracic Outlet Syndrome – Pharmacologic Strategies
36.Pain Management in NTOS – Advanced Techniques
37.Psychosocial Factors in NTOS
38.Psychiatric Considerations in NTOS
39.Assessment and Treatment of Recurrent NTOS
40.Outcomes After Treatment of NTOS
41.Directions in Clinical Research on NTOS
42.Controversies in NTOS: Is Laboratory Testing Necessary in Patients with NTOS?
43.Controversies in NTOS: Inflammation and Symptom Formation in NTOS
44.Controversies in NTOS: Transaxillary or Supraclavicular First Rib Resection in NTOS?
45.Controversies in NTOS: To Remove the First Rib or Not?
46.Controversies in NTOS: Is NTOS Overdiagnosed or Underdiagnosed?
47.Controversies in NTOS: Is TO Decompression a Vascular, Thoracic, or Neurosurgical Procedure?
48.VTOS for the Primary Care Team: When to Consider the Diagnosis
49.Anatomy and Pathophysiology of VTOS
50.Clinical Presentation and Patient Evaluation in VTOS
51.VTOS in the Patient Requiring Chronic Hemodialysis Access
52.VTOS in the Pediatric Age Group
53.VTOS in the Competitive Athlete
54.Advanced Imaging for Vascular TOS
55.Differential Diagnosis, Decision-Making, and Pathways of Care for VTOS
56.Management of the Patient Who Presents Late After Thrombosis
57.Conservative (Non-Operative) Treatment of VTOS
58.Hypercoagulable Conditions and VTOS
59.Physical and Occupational Therapy for Patients with VTOS
60.Surgical Techniques: Thrombolysis, IVUS, and Balloon Angioplasty for VTOS
61.Surgical Techniques: Operative Decompression Using the Transaxillary Approach for VTOS
62.Surgical Techniques: Operative Decompression Using the Infraclavicular Approach for VTOS
63.Surgical Techniques: Operative Decompression Using the Paraclavicular Approach for VTOS
64.Surgical Techniques: Medial Claviculectomy for VTOS
65.Surgical Techniques: Jugular Turndown and Other Venous Reconstructions for VTOS
66.VTOS: Postoperative Care
67.Outcomes After Treatment of VTOS
68.Assessment and Treatment of Recurrent VTOS
69.Directions in Clinical Research on VTOS
70.Controversies in VTOS: Is Lysis Always Required in Patient with Effort Thrombosis?
71.Controversies in VTOS: Is Costoclavicular Junction Decompression Always Needed in VTOS?
72.Controversies in VTOS: Timing of First Rib Resection After Thrombolysis
73.Controversies in VTOS: What Is the Best Approach to the First Rib in VTOS?
74.Controversies in VTOS: Is There Ever a Role for Venous Stents in VTOS?
75.Controversies in VTOS: How Long Should Anticoagulation Be Used in VTOS?
76.Controversies in VTOS: What to Do About the Contralateral Side?
77.Anatomy and Pathophysiology of ATOS
78.Clinical Presentation and Patient Evaluation in ATOS
79.Management of Digital Emboli, Vasospasm, and Ischemia in ATOS
80.ATOS in the Competitive Athlete
81.Congenital Abnormalities, Cervical Ribs, and Related Bony Abnormalities
82.ATOS in the Pediatric Age Group
83.Differential Diagnosis, Decision-Making, and Pathways of Care for ATOS
84.Surgical Techniques: Thrombolysis and Endovascular Intervention for ATOS
85.Surgical Techniques: Approach to the Axillosubclavian Artery
86.Surgical Techniques: Axillary Artery Reconstruction for ATOS
87.Outcomes After Treatment of ATOS
88.Assessment and Treatment of Recurrent/Residual ATOS
89.Directions in Clinical Research on ATOS
90.TOS: The Perspective of the Patient
91.Nerve and Arterial Injury After First Rib Resection
92.Postoperative Complex Regional Pain Syndrome
93.Functional Outcome and Quality-of-Life Assessment Instruments in TOS
94.Medicolegal Issues in TOS
95.Disability and Workman’s Compensation Issues in TOS
96.Internet-Based Patient and Clinician Resources for TOS
97.Establishing a TOS-Focused Practice

- Definitive text on thoracic outlet syndrome (TOS)
- Comprehensive resource on all clinical aspects of the condition
- Provides standardized evidence-based information on TOS topics

Thoracic outlet syndrome (TOS) is a condition estimated to affect as many as 80 of every 1000 patients in the US alone. While estimates vary widely based in part on lack of consensus as to the definition of the syndrome, as many as 3000 first rib resections are performed annually in the US. TOS comprises at least three separate conditions. The most common, neurogenic TOS, refers to the condition where the brachial plexus is compressed at the scalene triangle or retropectoral space, and is manifest as local and extremity pain and neurologic symptoms. Venous TOS refers to the situation where the subclavian vein is compressed by the structures making up the costoclavicular junction, and presents as acute or chronic venous thrombosis or injury or occasionally intermittent positional obstruction. Finally, arterial TOS refers to the situation where arterial injury occurs as the result of abnormal bony or ligamentous structures at the outlet, and presents as occlusion of or embolization from an abnormal artery in this area.
Thoracic Outlet Syndrome brings together many experts who treat this disease and are leaders in their fields. While it can certainly be read in its entirety (and should, by all who concentrate on this condition), it is designed to be a clinical reference, residing on a shelf in a busy surgical, vascular or neurologic clinic where individual chapters can be quickly referenced. As such, the chapters are thorough, but concise and useful to answer when a specific question arises in the course of daily practice.