Skip to main content
SpringerLink
Log in

Neurogenes Thoracic-outlet-Syndrom (nTOS)

Neurogenic thoracic outlet syndrome (nTOS)

  • Leitthema
  • Published:
Gefässchirurgie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Das neurogene Thoracic-outlet-Syndrom (nTOS), gilt im Hinblick auf Diagnose und Therapie unverändert als umstritten, ursächlich hierfür ist in erster Linie das Fehlen klar definierter Diagnosekriterien.

Zielsetzung

Zielsetzung der vorliegenden Übersichtsarbeit ist die relevante Literatur im Hinblick auf die Definition des nTOS, insbesondere auf Diagnosekriterien, Differenzialdiagnose und Therapiealternativen darzustellen.

Ergebnisse

Trotz einer Vielzahl von Fallserien in der Literatur ist die Datenlage zum nTOS schlecht. Die kritischen Punkte liegen in fehlenden allgemein akzeptierten Diagnosekriterien, welche die Vergleichbarkeit der einzelnen Serien einschränkt. Darüber hinaus sind Daten zum Langzeitverlauf unter den verschiedenen Therapiemodalitäten sowie zum natürlichen Verlauf des nTOS spärlich.

Schlussfolgerung

Die Datenlage zum nTOS ist schlecht. Die Diagnose eines nTOS, insbesondere beim Fehlen objektivierbarer neurologischer Symptome sollte nur unter äußerster Zurückhaltung gestellt werden. Neuere Diagnoseverfahren, wie die MR-Neurographie sind ggf. in der Lage, mehr diagnostische Klarheit zu bringen. Die konservative, physiotherapeutische Therapie ist die Basistherapie des nTOS. Unter kritischer Indikationsstellung zu einer Operation sind im Langzeitverlauf etwa 62 % der Patienten beschwerdefrei, etwa 80 % gebessert.

Abstract

Background

Neurogenic thoracic outlet syndrome (nTOS) is one of the most controversial nerve compression syndromes. Especially for the subgroup of atypical nTOS no clear diagnostic criteria are defined.

Objectives

The aim of this article is to illustrate the relevant literature with respect to diagnostic criteria, differential diagnosis and therapeutic options for nTOS.

Results

Despite a vast number of retrospective and case studies there is very low quality evidence regarding nTOS. There is a lack of generally accepted diagnostic criteria for nTOS and particularly atypical nTOS. In addition long-term follow-up studies and studies of the natural course of nTOS are sparse.

Conclusions

According to the current literature the level of evidence for nTOS is low. Diagnosis should be made restrictively, especially when objectifiable neurological symptoms are lacking. Recently developed imaging modalities, such as magnetic resonance (MR) neurography might be able to objectify the diagnosis of nTOS. Conservative treatment is considered to be the basic therapy of nTOS. Surgical treatment with restricted medical indications has led to an improvement of symptoms in approximately 80 % of patients and approximately 62 % of patients were free of complaints.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Adson AW, Coffey JR (1927) Cervical rib: a method of anterior approach for relief of symptoms by division of the scalenus anticus. Ann Surg 85:839–857

    PubMed  CAS  Google Scholar 

  2. Adson AW (1947) Surgical treatment for symptoms produced by cervical ribs and the scalenus anticus muscle. Surg Gynecol Obstet 85:687–700

    PubMed  CAS  Google Scholar 

  3. Cherington M, Happer I, Machanic B, Parry L (1986) Surgery for thoracic outlet syndrome may be hazardous to your health. Muscle Nerve 9:632–634

    Article  PubMed  CAS  Google Scholar 

  4. Cooper A, Travers B (1817) On Exostosis. In: Cooper A, Travers B (Hrsg) Surgical essays. Cox and Son, Longman, Hunt, Rees, Orme Brown, London Constable, Edinburgh, Smith and Son, Glasgow, Hodges and Mc Arthur, Dublin S 21–24

  5. Coote H (1861) Exostosis of the left transverse process of the seventh cervical vertebra, surrounded by blood vessels and nerves, successful removal. Lancet i:360–361

    Article  Google Scholar 

  6. Demos NJ, Rubenstein H, Restivo C (1980) Role of scalenotomy for relief of positional vertebro-basilar ischaemia. J Med Soc N J 6:419–422

    Google Scholar 

  7. Falconer MA, Weddel G (1943) Costo-clavicular compression of the subclavian artery and vein. Relation to scalenus syndrome. Lancet ii:539–543

    Article  Google Scholar 

  8. Foley JM, Finlayson A, Travlos A (2012) A review of thoracic outlet syndrome and the possible role of botulinum toxin in the treatment of this syndrome. Toxins 4:1223–1235

    Article  PubMed  Google Scholar 

  9. Gilliatt RW, LeQuesne PM, Logue V, Sumner AJ (1970) Wasting of the hand associated with a cervical rib or band. J Neurol Neurosurg Psychiatry 33:615–626

    Article  PubMed  CAS  Google Scholar 

  10. Henry AK (1924) A new method of recection the left cervicothoracic ganglion of the sympathetic chain in angina pectoris. Ir J Med Sci V:156–157

    Google Scholar 

  11. Jerret SA, Cuzzone LJ, Pasternak BM (1984) Thoracic outlet syndrome. Arch Neurol 41:960–968

    Article  Google Scholar 

  12. König RW, Kretschmer T, Börm W et al (2005) Neurogenes Thoracic-Outlet-Syndrom: Langzeitergebnisse der supraklavikulären Dekompression. Nervenarzt 76:1222–1230

    Article  PubMed  Google Scholar 

  13. Lindgren KA (1997) Conservative treatment of thoracic outlet syndrome: a 2-year follow-up. Arch Phys Med Rehabil 78:373–378

    Article  PubMed  CAS  Google Scholar 

  14. Lord JW (1981) Thoracic outlet syndromes. Real or imaginary? NY State J Med 81:1488–1489

    Google Scholar 

  15. McGough E, Pearce M, Byrne J (1979) Management of thoracic outlet syndrome. J Thorac Cardiovasc Surg 77:169–172

    PubMed  CAS  Google Scholar 

  16. Murphy T (1910) Brachial plexus neuritis caused by pressure of first rib. Med J Aust 15:582–585

    Google Scholar 

  17. Nafziger HC, Grant WT (1938) Neuritis of the brachial plexus mechanical in origin. Surg Gynecol Obstet 67:722–730

    Google Scholar 

  18. Nelson DA (1990) Thoracic outlet syndrome and dysfunction of the temporomandibular joint: proved pathology or pseudosyndromes? Perspect Biol Med 33:567–576

    PubMed  CAS  Google Scholar 

  19. Nishida T, Price SJ, Minieka MM (1993) Medial antebrachial cutaneous nerve conduction in true neurogenic thoracic outlet syndrome. Electromyogr Clin Neurophysiol 33:285–288

    PubMed  CAS  Google Scholar 

  20. Oberle J, Richter HP (1996) Die operative Behandlung des Thoracic-outlet-Syndroms. Befunde, OP-Maßnahmen, Ergebnisse und Komplikationen bei 38 Patienten. Aktuelle Neurol 23:239–244

    Article  Google Scholar 

  21. Ochsner A, Gage M, DeBakey M (1935) Skalenus anterior (Naffziger) syndrome. Am J Surg 28:695–699

    Google Scholar 

  22. Patton GM (2004) Arterial thoracic outlet syndrome. Hand Clin 20(1):107–111

    Article  PubMed  Google Scholar 

  23. Peet RM, Henriksen JD, Anderson THP, Martin GM (1956) Thoracic-outlet syndrome: evaluation of a therapeutic exercise program. Mayo Clin Proc 31:281–284

    CAS  Google Scholar 

  24. Poitevin L (1988) Proximal compression of the upper limb neurovascular bundle: an anatomic research study. Hand Clin 4:575–580

    PubMed  CAS  Google Scholar 

  25. Roos DB, Owens JC (1966) Thoracic outlet syndrome. Arch Surg 93:71–72

    Article  PubMed  CAS  Google Scholar 

  26. Roos DB (1976) Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis and treatment. Am J Surg 132:771–778

    Article  PubMed  CAS  Google Scholar 

  27. Rousseff R, Tzetanov P, Valkov I (2005) Utility (or futility?) of electrodiagnosis in thoracic outlet syndrome. Electromyogr Clin Neurophysiol 45(3):131–133

    PubMed  CAS  Google Scholar 

  28. Sanders RJ, Monsour JW, Gerber WF, Pearce WH (1979) Scalenotomy versus first rib excision for treatment of the thoracic outlet syndrome. Surgery 85:109–121

    PubMed  CAS  Google Scholar 

  29. Sanders RJ, Hammond SL (2004) Venous thoracic outlet syndrome. Hand Clin 20(1):113–118

    Article  PubMed  Google Scholar 

  30. Wehbé MA (2004) Preface. Thoracic outlet syndrome. Hand Clin 20:1–5

    Article  PubMed  Google Scholar 

  31. Wilboun AJ, Porter JM (1982) Neurogenic thoracic outlet syndrome: surgical versus conservative therapy. J Vasc Surg 15(5):880–882

    Article  Google Scholar 

  32. Wilbourn AJ, Porter JM (1988) Thoracic outlet syndrome. Spine 2:597–626

    Google Scholar 

  33. Wright IS (1945) The neurovascular syndrome produced by hyperabduction of the arms: the immediate changes produced in 15 normal controls, and the effects on some persons of prolonged hyperabduction of the arms, as in sleeping and certain occupations. Am Heart J 29:1149–1151

    Article  Google Scholar 

Download references

Compliance with ethics guidelines

Conflict of interest R.W. König, M.T. Pedro, T. Kapapa, J. Oberhoffer, C. Wirtz and G. Antoniadis declare that they have no conflict of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

Additional informed consent was obtained from all patients for whom identifying information is included in this article.

Author information

Authors and Affiliations

  1. Neurochirurgische Klinik, Universität Ulm, BKH Günzburg, L.-Heilmeyer-Str. 2, 89312, Günzburg, Deutschland

    R.W. König, M.T. Pedro, J. Oberhoffer, C. Wirtz & G. Antoniadis

  2. Neurochirurgische Klinik, Universität Ulm, Chirurgisches Zentrum Ulm, Ulm, Deutschland

    R.W. König, T. Kapapa & C. Wirtz

Authors
  1. R.W. König
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M.T. Pedro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Kapapa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Oberhoffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Wirtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Antoniadis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R.W. König.

Rights and permissions

Reprints and permissions

About this article

Cite this article

König, R., Pedro, M., Kapapa, T. et al. Neurogenes Thoracic-outlet-Syndrom (nTOS). Gefässchirurgie 18, 201–205 (2013). https://doi.org/10.1007/s00772-013-1158-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00772-013-1158-0

Schlüsselworte

Keywords

Search

Navigation