Diagnosis of nTOS is clinical, and the best screening test is the ULTT. The most common symptoms are pain and paresthesias of the head, neck, and upper extremities. The most common form of TOS is neurogenic. Anticoagulation and surgical decompression remain the treatment of choice for vascular versions of TOS. Surgery in nTOS is considered for refractory cases only. Data are limited, therefore there is no conclusive evidence that any one treatment method or combination is more effective. ![]() Initial treatment for neurogenic TOS (nTOS) is often conservative. If TOS is suspected, additional diagnostic testing such as ultrasound, electromyography (EMG), or magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) might be utilized to further distinguish the vascular or neurological etiologies of the symptoms. A positive ULTT should be followed up with an elevated arm stress test (EAST) to further support the diagnosis. The best initial provocative test to screen for TOS is the upper limb tension test (ULTT) because a negative test suggests against brachial plexus compression. Symptoms of hemicranial and/or upper-extremity pain and paresthesias should lead a physician to evaluate for musculoskeletal etiologies that may be contributing to the compression of the brachial plexus. A final search was conducted prior to submission for publication to check for updated articles. A total of 187 articles were utilized in the final preparation of this manuscript. The authors added a total of 20 articles that fell outside of the search criteria, as they considered them to be historic in nature with regards to TOS (n=8), were related specifically to OMT (n=4), or were considered sentinel articles relating to specific therapeutic interventions (n=8). Articles pertaining specifically to osteopathic manipulative treatment (OMT) were sparse and all were utilized (n=6). Articles over 5 years old pertaining to therapeutic intervention (mostly surgical) were removed (n=18). The other exclusion criteria included: non-English language (n=21) no abstracts available (n=56) and case reports of TOS occurring from complications of fractures, medical or surgical procedures, novel surgical approaches, or abnormal anatomy (n=42). Of the remaining 307 articles, duplicate citations not removed by automated means were removed manually (n=3). The remaining 1,078 citations were manually reviewed, with articles published prior to 2010 removed (n=771). The automated merge feature removed duplicate articles. A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) systematic literature review was conducted to identify the most common etiologies, the most objective findings, and the most effective nonsurgical treatment options for TOS. ![]() The PubMed database was conducted for the range of May 2020 to September 2021 utilizing TOS-related Medical Subject Headings (MeSH) terms. This article summarizes what is currently published about TOS, its etiologies, common objective findings, and nonsurgical treatment options. A PubMed search was undertaken to present a comprehensive article addressing the presentation and treatment for TOS. Thoracic outlet syndrome (TOS) symptoms are prevalent and often confused with other diagnoses.
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