Algorithm for Surgical Decision Making in Patients with Thoracic Outlet Syndrome

Purpose: Historically the classification of Thoracic Outlet Syndrome (TOS) has been based on symptoms rather than underlying pathology. Therefore, TOS classified into Neurogenic (NTOS), Venous (VTOS or Paget Schroetter Syndrome) and Arterial (ATOS) subgroups. This resulted in confusion among medical practitioners, difficulty making diagnosis, poor results with surgical intervention. Methods: The published papers from PubMed newer understanding pathogenesis treatment were reviewed. Results: More recently pathologic entity. Based this classification, patients who are suspected having should be as 1. Cervical Rib Disease (CRD), 2. result “Subclavian Vein Compression Syndrome”. more accurate better patient selection for surgery, excellent results. paper outlines algorithm appropriate diagnosis present neurovascular upper extremity surgery. Conclusion: decision making, undergo cervical exploration resection entity which compression brachial plexus subclavian artery neck. Patients outlet found to have extrinsic vein by a tubercle at sternocostal joint Multiphasic MRA robotic first rib resection.