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Diagnosis of Neurogenic Thoracic Outlet Syndrome: 2016 Consensus Guidelines and Other Strategies

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Thoracic Outlet Syndrome

Abstract

The diagnosis of neurogenic thoracic outlet syndrome (TOS) depends upon clinical suspicion, pattern-recognition, and exclusion of more common conditions that have overlapping features. In most patients a diagnosis of neurogenic TOS can be made or excluded on the basis of the clinical history, description of symptoms, and physical examination. The clinical diagnosis may then be supported, clarified, or challenged by a limited number of adjunctive diagnostic studies. In this chapter the clinical diagnosis of neurogenic TOS is described along with the development of consensus-based clinical diagnostic criteria for this condition by the Consortium for Outcomes Research and Education on Thoracic Outlet Syndrome (CORE-TOS) and the Society for Vascular Surgery (SVS) committee on reporting standards for TOS. Application of these diagnostic criteria in a prospective, observational, cohort study is illustrated. Broader use of these diagnostic criteria will be a valuable step toward achieving more consistent clinical care and improved comparative effectiveness research for neurogenic TOS.

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Acknowledgments

The following individuals participated in the CORE-TOS clinical research development of consensus-based diagnostic criteria for neurogenic TOS: David C. Cassada, MD, (Vascular Surgery) University of Tennessee, Knoxville, TN; Dean M. Donahue, MD, (Thoracic Surgery) Harvard Medical School and Massachusetts General Hospital, Boston, MA; Peter I. Edgelow, DPT, (Physical Therapy) Hayward Physical Therapy, San Francisco, CA; Julie A. Freischlag, MD, (Vascular Surgery) Johns Hopkins University and Johns Hopkins Hospital, Baltimore, MD; Hugh A. Gelabert, MD, (Vascular Surgery) David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA; Karl A. Illig, MD, (Vascular Surgery) University of Rochester, Rochester, NY; Kaj H. Johansen, MD, PhD, (Vascular Surgery) The Polyclinic Vascular Surgery Cherry Hill; Seattle, WA; Sheldon E. Jordan, MD, (Neurology) University of California-Los Angeles, Los Angeles, CA; Gregory J. Pearl, MD, (Vascular Surgery) Baylor University Medical Center and Baylor-Hamilton Heart and Vascular Hospital, Dallas, TX; Richard J. Sanders, MD, (Vascular Surgery) Rose Medical Center; Denver, CO; Carlos A. Selmonosky, MD, (Thoracic and Cardiovascular Surgery) Inova Fairfax Hospital, Falls Church, VA; and Robert W. Thompson, MD, (Vascular Surgery) Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO.

This work was supported in part by the Thoracic Outlet Syndrome Research and Education Fund of the Foundation for Barnes Jewish Hospital, BJC Healthcare, St. Louis, Missouri. The author is indebted to our clinical office staff and collaborating pain management and physical therapy experts for helping to care for our patients with neurogenic TOS.

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Thompson, R.W. (2021). Diagnosis of Neurogenic Thoracic Outlet Syndrome: 2016 Consensus Guidelines and Other Strategies. In: Illig, K.A., et al. Thoracic Outlet Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-030-55073-8_9

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