Thoracic Outlet Syndrome: Prevention [Clinical Review Discussion]

Risk factors and prevention strategies for thoracic outlet syndrome (TOS) are very difficult to access for a number of reasons.  Since its introduction as a diagnostic term in 1956 (1) the diagnosis itself has remained controversial with some doubting the clinical entity even exists (2).  Thoracic outlet syndrome has become an umbrella diagnosis that includes scalenus anticus syndrome, cervical rib syndrome, costo-clavicular syndrome and  hyperabduction syndrome, to name just a few (3).  Additionally the diagnosis is primarily a clinical diagnosis since examination, electrodiagnostic and imaging findings have low specificity and sensitivity (4).  Finally few clinical trials have examined efficacy of TOS interventions, much less prevention strategies.  As a result risk factors and prevention strategies identified are based on weak evidence and are largely expert opinion.

The reported incidence of TOS covers a broad range, from 0.3% to 8%, and is reflective of the uncertainty of the diagnosis (5).