Critical review of pathophysiologic mechanisms in thoracic outlet syndrome (TOS).

BACKGROUND

Thoracic outlet syndrome is a complex and multifactorial disease. There are multiple diagnostic steps and possible treatment options. The scientific literature not always contributes to a "unifying vision".

METHOD

We did an overview of the actual literature on TOS in the last 20 years and confronted these views with our surgical experience (about 50 cases and 10 operations). After preparing a special issue in the German Journal of Hand Surgery (Handchirurgie Mikrochirurgie Plastische Chirurgie), where landmark papers were edited on anatomy, pathophysiology, diagnosis and treatment, we summarise our knowledge in this "strategic" paper.

FINDINGS

To understand and treat TOS correctly, surgical experience in brachial plexus surgery is mandatory. The very well written basic papers on anatomy and its variations must be studied in detail. Neurophysiologic and vascular examinations are mandatory. A conservative treatment always must be tried first. Postoperative outcome should be clearly correlated with the technical steps within the surgical procedure.

CONCLUSION

TOS diagnosis and treatment is complex, but rewarding. The symptom complex must be identified and no longer be considered as psychogenic. There is still need for better spread of information among neurologists, surgeons, and work compensation companies.