Neuromuscular DiseasesNeuromuscular DiseasesНервно-мышечные болезни2222-87212413-0443Publishing House ABV Press23510.17650/2222-8721-2017-7-4-10-19LECTURES AND REVIEWSЛЕКЦИИ И ОБЗОРЫThoracic outlet syndrome: clinical and diagnostic featuresСиндром верхней апертуры грудной клетки: клинические и диагностические особенностиMurtazinaA. F.МуртазинаА. Ф.
Russian Federation

Build. 2, 17 Krzhizhanovskogo St., Moscow 117258, Russia

Россия, 117258 Москва, ул. Кржижановского, 17/2

aysylumurtazina@gmail.comNikitinS. S.НикитинС. С.
Russian Federation

Build. 2, 17 Krzhizhanovskogo St., Moscow 117258, Russia

Россия, 117258 Москва, ул. Кржижановского, 17/2

NaumovaE. S.НаумоваЕ. С.
Russian Federation

Build. 2, 17 Krzhizhanovskogo St., Moscow 117258, Russia

Россия, 117258 Москва, ул. Кржижановского, 17/2

Medical Center “Practical Neurology”, Association of Neuromuscular Disorders SpecialistsМедицинский центр «Практическая неврология»110120187410191101201811012018Copyright ©; 2018, Murtazina A.F., Nikitin S.S., Naumova E.S.Copyright ©; 2018, Муртазина А.Ф., Никитин С.С., Наумова Е.С.2018Murtazina A.F., Nikitin S.S., Naumova E.S.Муртазина А.Ф., Никитин С.С., Наумова Е.С.https://creativecommons.org/licenses/by/4.0https://nmb.abvpress.ru/jour/article/view/235

Since the term “thoracic outlet syndrome” (TOS) has been introduced, there have been disputes about the accuracy of the diagnosis, definition, diagnostic workup and treatment of this condition. Existing  clinical variants include involvement of blood vessels and nerve fibers. Neurogenic TOS, consisting of the brachial plexus compression, is the most common variant of TOS, which is also the most hardly proven  by physical findings, imaging or electrodiagnostic studies. A long history of searching the “gold standard” for TOS diagnosis has led to a  large number of publications. The current paper reviews the symptoms and diagnostic approaches to the neurogenic TOS.

С тех пор как был введен термин «синдром верхней апертуры грудной клетки» (thoracic outlet syndrome, TOS), не прекращаются споры о правомерности такого диагноза, его дефинициях,  возможной диагностике и лечении. Заинтересованность разных анатомических структур  обусловливает многообразие клинических вариантов. Факт поражения плечевого сплетения  при наиболее частом варианте болезни – нейрогенном – редко удается подтвердить  инструментально. За 60 лет поисков «золотого стандарта» диагностики TOS накопилось  большое количество публикаций. В обзоре уделено внимание клиническим проявлениям  нейрогенного варианта, а также рассмотрены методы инструментальной диагностики этой патологии.

thoracic outlet syndromeneurogenic TOSarterial vascular TOSvenous vascular TOSinterscalene spacecostoclavicular spacesubpectoral spaceсиндром верхней апертуры грудной клеткинейрогенный TOSартериальный TOSвенозный TOSмежлестничное пространствореберно-ключичное пространствосубпекторальное пространство1. Adson A.W., Coffey J.R. Сervical rib: a method of anterior approach for relief of symptoms by division of the scalenusanticus. Ann Surg 1927;85(6):839–57. PMID: 17865683.Adson A.W., Coffey J.R. Сervical rib: a method of anterior approach for relief of symptoms by division of the scalenusanticus. Ann Surg 1927;85(6):839–57. PMID: 17865683.2. Roos D.B. Historical perspectives and anatomic considerations. Semin Thorac Cardiovasc Surg 1996;8(2):183–9. PMID: 8672572.Roos D.B. Historical perspectives and anatomic considerations. Semin Thorac Cardiovasc Surg 1996;8(2):183–9. PMID: 8672572.3. Peet R.M., Henriksen J.D., Anderson T.P., Martin G.M. Thoracic-outlet syndrome: evaluation of a therapeutic exercise program. Proc Staff Meet Mayo Clin 1956;31(9):281–7. PMID: 13323047.Peet R.M., Henriksen J.D., Anderson T.P., Martin G.M. Thoracic-outlet syndrome: evaluation of a therapeutic exercise program. Proc Staff Meet Mayo Clin 1956;31(9):281–7. PMID: 13323047.4. Chang K., Graf E., Davis K. et al. Spectrum of thoracic outlet syndrome presentation in adolescents. Arch Surg 2011;146(12):1383–7. DOI: 10.1001/archsurg.2011.739. PMID: 22184299.Chang K., Graf E., Davis K. et al. Spectrum of thoracic outlet syndrome presentation in adolescents. Arch Surg 2011;146(12):1383–7. DOI: 10.1001/archsurg.2011.739. PMID: 22184299.5. Bahm J. Critical review of pathophysiologic mechanisms in thoracic outlet syndrome (TOS). Acta Neurochir Suppl 2007;100:137–9. DOI: 10.1007/978-3-211-72958-8_29. PMID: 17985563.Bahm J. Critical review of pathophysiologic mechanisms in thoracic outlet syndrome (TOS). Acta Neurochir Suppl 2007;100:137–9. DOI: 10.1007/978-3-211-72958-8_29. PMID: 17985563.6. Wilbourn A.J. Thoracic outlet syndrome is overdiagnosed. Muscle Nerve 1999;22(1):130– 6; discussion 136–7. PMID: 9883870.Wilbourn A.J. Thoracic outlet syndrome is overdiagnosed. Muscle Nerve 1999;22(1):130– 6; discussion 136–7. PMID: 9883870.7. Brantigan C.O., Roos D.B. Diagnosing thoracic outlet syndrome. Hand Clin 2004;20(1):27– 36. DOI: http://dx.doi.org/10.1016/S0749-0712(03)00080-5. PMID: 15005381.Brantigan C.O., Roos D.B. Diagnosing thoracic outlet syndrome. Hand Clin 2004;20(1):27– 36. DOI: http://dx.doi.org/10.1016/S0749-0712(03)00080-5. PMID: 15005381.8. Buller L.T., Jose J., Baraga M., Lesniak B. Thoracic outlet syndrome: current concepts, imaging features, and therapeutic strategies. Am J Orthop (Belle Mead NJ) 2015;44(8):376– 82. PMID: 26251937.Buller L.T., Jose J., Baraga M., Lesniak B. Thoracic outlet syndrome: current concepts, imaging features, and therapeutic strategies. Am J Orthop (Belle Mead NJ) 2015;44(8):376– 82. PMID: 26251937.9. Ferrante M.A. The thoracic outlet syndromes. Muscle Nerve 2012;45(6): 780–95. DOI: 10.1002/mus.23235. PMID: 22581530.Ferrante M.A. The thoracic outlet syndromes. Muscle Nerve 2012;45(6): 780–95. DOI: 10.1002/mus.23235. PMID: 22581530.10. Laulan J., Fouquet B., Rodaix C. et al. Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact. J Occup Rehabilit 2011;21(3):366–73. DOI: 10.1007/s10926-010-9278-9. PMID: 21193950.Laulan J., Fouquet B., Rodaix C. et al. Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact. J Occup Rehabilit 2011;21(3):366–73. DOI: 10.1007/s10926-010-9278-9. PMID: 21193950.11. Sanders R.J., Hammond S.L., Rao N.M. Diagnosis of thoracic outlet syndrome. J Vasc Surg 2007;46(3):601–4. DOI: 10.1016/j.jvs.2007.04.050. PMID: 17826254.Sanders R.J., Hammond S.L., Rao N.M. Diagnosis of thoracic outlet syndrome. J Vasc Surg 2007;46(3):601–4. DOI: 10.1016/j.jvs.2007.04.050. PMID: 17826254.12. Watson L.A., Pizzari T., Balster S. Thoracic outlet syndrome part 1: clinical manifestations, differentiation and treatment pathways. Man Ther 2009;14(6):586–95. DOI: 10.1016/j.math.2009.08.007. PMID: 19744876.Watson L.A., Pizzari T., Balster S. Thoracic outlet syndrome part 1: clinical manifestations, differentiation and treatment pathways. Man Ther 2009;14(6):586–95. DOI: 10.1016/j.math.2009.08.007. PMID: 19744876.13. Екимовская Е.В., Разумовский А.Ю., Рачков В.Е. Синдром верхней апертуры грудной клетки у детей. Детская хирургия 2011;5:46–50. [Ekimovskaya E.V., Razumovskyy A.Yu., Rachkov V.E. Superior thoracic outlet syndrome in children. Detskaya Khirurgiya = Russian Journal of Pediatric Surgery 2011;5:46–50. (In Russ.)].Екимовская Е.В., Разумовский А.Ю., Рачков В.Е. Синдром верхней апертуры грудной клетки у детей. Детская хирургия 2011;5:46–50. [Ekimovskaya E.V., Razumovskyy A.Yu., Rachkov V.E. Superior thoracic outlet syndrome in children. Detskaya Khirurgiya = Russian Journal of Pediatric Surgery 2011;5:46–50. (In Russ.)].14. Doneddu P.E., Coraci D., De Franco P. et al. Thoracic outlet syndrome: wide literature for few cases. Status of the art. Neurol Sci 2017;38(3):383–8. DOI: 10.1007/s10072-016-2794-4. PMID: 27987052.Doneddu P.E., Coraci D., De Franco P. et al. Thoracic outlet syndrome: wide literature for few cases. Status of the art. Neurol Sci 2017;38(3):383–8. DOI: 10.1007/s10072-016-2794-4. PMID: 27987052.15. Klaassen Z., Sorenson E., Tubbs R.S. et al. Thoracic outlet syndrome: a neurological and vascular disorder. Clin Anat 2014;27(5):724–32. DOI: 10.1002/ca.22271. PMID: 23716186.Klaassen Z., Sorenson E., Tubbs R.S. et al. Thoracic outlet syndrome: a neurological and vascular disorder. Clin Anat 2014;27(5):724–32. DOI: 10.1002/ca.22271. PMID: 23716186.16. Ferrante M.A., Ferrante N.D. The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome. Muscle Nerve 2017;55(6):782– 93. DOI: 10.1002/mus.25536. PMID: 28006844.Ferrante M.A., Ferrante N.D. The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome. Muscle Nerve 2017;55(6):782– 93. DOI: 10.1002/mus.25536. PMID: 28006844.17. Ozoa G., Alves D., Fish D.E. Thoracic outlet syndrome. Phys Med Rehabil Clin North Am 2011;22(3):473–83. DOI: 10.1016/j.pmr.2011.02.010. PMID: 21824588.Ozoa G., Alves D., Fish D.E. Thoracic outlet syndrome. Phys Med Rehabil Clin North Am 2011;22(3):473–83. DOI: 10.1016/j.pmr.2011.02.010. PMID: 21824588.18. Laulan J. Thoracic outlet syndromes. The so-called “neurogenic types”. Hand Surg Rehabil 2016;35(3):155–64. DOI: 10.1016/j.hansur.2016.01.007. PMID: 27740456.Laulan J. Thoracic outlet syndromes. The so-called “neurogenic types”. Hand Surg Rehabil 2016;35(3):155–64. DOI: 10.1016/j.hansur.2016.01.007. PMID: 27740456.19. Mattox R., Battaglia P.J., Welk A.B. et al. Reference values for the scalene interval width during varying degrees of glenohumeral abduction using ultrasonography. J Manipulative Physiol Ther 2016;39(9):662–7. DOI: 10.1016/j.jmpt.2016.08.002. PMID: 28327294.Mattox R., Battaglia P.J., Welk A.B. et al. Reference values for the scalene interval width during varying degrees of glenohumeral abduction using ultrasonography. J Manipulative Physiol Ther 2016;39(9):662–7. DOI: 10.1016/j.jmpt.2016.08.002. PMID: 28327294.20. Talu G.K. Thoracic outlet syndrome. Agri 2005;17(2):5–9. PMID: 15977087.Talu G.K. Thoracic outlet syndrome. Agri 2005;17(2):5–9. PMID: 15977087.21. Jeung M.Y., Gangi A., Gasser B. et al. Imaging of chest wall disorders. Radiographics 1999;19(3):617–37. DOI: 10.1148/radiographics.19.3.g99ma02617. PMID: 10336192.Jeung M.Y., Gangi A., Gasser B. et al. Imaging of chest wall disorders. Radiographics 1999;19(3):617–37. DOI: 10.1148/radiographics.19.3.g99ma02617. PMID: 10336192.22. Lapegue F., Faruch-Bilfeld M., Demondion X. et al. Ultrasonography of the brachial plexus, normal appearance and practical applications. Diagn Interv Imaging 2014;95(3):259– 75. DOI: 10.1016/j.diii.2014.01.020. PMID: 24603038.Lapegue F., Faruch-Bilfeld M., Demondion X. et al. Ultrasonography of the brachial plexus, normal appearance and practical applications. Diagn Interv Imaging 2014;95(3):259– 75. DOI: 10.1016/j.diii.2014.01.020. PMID: 24603038.23. Baumer P., Kele H., Kretschmer T. et al. Thoracic outlet syndrome in 3T MR neurography- fibrous bands causing discernible lesions of the lower brachial plexus. Eur Radiol 2014;24(3):756–61. DOI: 10.1007/s00330-013-3060-2. PMID: 24272223.Baumer P., Kele H., Kretschmer T. et al. Thoracic outlet syndrome in 3T MR neurography- fibrous bands causing discernible lesions of the lower brachial plexus. Eur Radiol 2014;24(3):756–61. DOI: 10.1007/s00330-013-3060-2. PMID: 24272223.24. Ellison D.W., Wood V.E. Trauma-related thoracic outlet syndrome. J Hand Surg Br 1994;19(4):424–6. PMID: 7964090.Ellison D.W., Wood V.E. Trauma-related thoracic outlet syndrome. J Hand Surg Br 1994;19(4):424–6. PMID: 7964090.25. Machleder H.I., Moll F., Verity M.A. The anterior scalene muscle in thoracic outlet compression syndrome. Histochemical and morphometric studies. Arch Surg 1986;121(10):1141–4. PMID: 3767646.Machleder H.I., Moll F., Verity M.A. The anterior scalene muscle in thoracic outlet compression syndrome. Histochemical and morphometric studies. Arch Surg 1986;121(10):1141–4. PMID: 3767646.26. Ferrante M.A., Ferrante N.D. The thoracic outlet syndromes: Part 2. The arterial, venous, neurovascular, and disputed thoracic outlet syndromes. Muscle Nerve 2017;56(4):663–73. DOI: 10.1002/mus.25535. PMID: 28006856.Ferrante M.A., Ferrante N.D. The thoracic outlet syndromes: Part 2. The arterial, venous, neurovascular, and disputed thoracic outlet syndromes. Muscle Nerve 2017;56(4):663–73. DOI: 10.1002/mus.25535. PMID: 28006856.27. Patton G.M. Arterial thoracic outlet syndrome. Hand Clin 2004;20(1):107–11. DOI: 10.1016/S0749-0712(03)00086-6. PMID: 15005392.Patton G.M. Arterial thoracic outlet syndrome. Hand Clin 2004;20(1):107–11. DOI: 10.1016/S0749-0712(03)00086-6. PMID: 15005392.28. Butros S.R., Liu R., Oliveira G.R. et al. Venous compression syndromes: clinical features, imaging findings and management. Br J Radiol 2013;86(1030):20130284. DOI: 10.1259/bjr.20130284. PMID: 23908347.Butros S.R., Liu R., Oliveira G.R. et al. Venous compression syndromes: clinical features, imaging findings and management. Br J Radiol 2013;86(1030):20130284. DOI: 10.1259/bjr.20130284. PMID: 23908347.29. Zucker E.J., Ganguli S., Ghoshhajra B.B. et al. Imaging of venous compression syndromes. Cardiovasc Diagn Ther 2016;6(6):519–32. DOI: 10.21037/cdt.2016.11.19. PMID: 28123973.Zucker E.J., Ganguli S., Ghoshhajra B.B. et al. Imaging of venous compression syndromes. Cardiovasc Diagn Ther 2016;6(6):519–32. DOI: 10.21037/cdt.2016.11.19. PMID: 28123973.30. Christo P.J., McGreevy K. Updated perspectives on neurogenic thoracic outlet syndrome. Curr Pain Headache Rep 2011;15(1):14–21. DOI: 10.1007/s11916-010-0163-1. PMID: 21104206.Christo P.J., McGreevy K. Updated perspectives on neurogenic thoracic outlet syndrome. Curr Pain Headache Rep 2011;15(1):14–21. DOI: 10.1007/s11916-010-0163-1. PMID: 21104206.31. Bottros M.M., AuBuchon J.D., McLaughlin L.N. et al. Exercise-enhanced, ultrasound- guided anterior scalene muscle/pectoralis minor muscle blocks can facilitate the diagnosis of neurogenic thoracic outlet syndrome in the high-performance overhead athlete. Am J Sports Med 2017;45(1):189–94. DOI: 10.1177/0363546516665801. PMID: 27664077.Bottros M.M., AuBuchon J.D., McLaughlin L.N. et al. Exercise-enhanced, ultrasound- guided anterior scalene muscle/pectoralis minor muscle blocks can facilitate the diagnosis of neurogenic thoracic outlet syndrome in the high-performance overhead athlete. Am J Sports Med 2017;45(1):189–94. DOI: 10.1177/0363546516665801. PMID: 27664077.32. Boezaart A.P., Haller A., Laduzenski S. et al. Neurogenic thoracic outlet syndrome: a case report and review of the literature. Int J Shoulder Surg 2010;4(2):27–35. DOI: 10.4103/0973-6042.70817. PMID: 21072145.Boezaart A.P., Haller A., Laduzenski S. et al. Neurogenic thoracic outlet syndrome: a case report and review of the literature. Int J Shoulder Surg 2010;4(2):27–35. DOI: 10.4103/0973-6042.70817. PMID: 21072145.33. Hooper T.L., Denton J., McGalliard M.K. et al. Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis. J Man Manip Ther 2010;18(2):74–83. DOI: 10.1179/106698110X12640740712734. PMID: 21655389.Hooper T.L., Denton J., McGalliard M.K. et al. Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis. J Man Manip Ther 2010;18(2):74–83. DOI: 10.1179/106698110X12640740712734. PMID: 21655389.34. Nichols A.W. Diagnosis and management of thoracic outlet syndrome. Curr Sports Med Rep 2009;8(5):240–9. DOI: 10.1249/JSR.0b013e3181b8556d. PMID: 19741351.Nichols A.W. Diagnosis and management of thoracic outlet syndrome. Curr Sports Med Rep 2009;8(5):240–9. DOI: 10.1249/JSR.0b013e3181b8556d. PMID: 19741351.35. Nord K.M., Kapoor P., Fisher J. et al. False positive rate of thoracic outlet syndrome diagnostic maneuvers. Electromyogr Clin Neurophysiol 2008;48(2): 67–74. PMID: 18435210.Nord K.M., Kapoor P., Fisher J. et al. False positive rate of thoracic outlet syndrome diagnostic maneuvers. Electromyogr Clin Neurophysiol 2008;48(2): 67–74. PMID: 18435210.36. Plewa M.C., Delinger M. The false-positive rate of thoracic outlet syndrome shoulder maneuvers in healthy subjects. Acad Emerg Med 1998;5(4):337–42. PMID: 9562199.Plewa M.C., Delinger M. The false-positive rate of thoracic outlet syndrome shoulder maneuvers in healthy subjects. Acad Emerg Med 1998;5(4):337–42. PMID: 9562199.37. Gilliatt R.W., Willison R.G., Dietz V., Williams I.R. Peripheral nerve conduction in patients with a cervical rib and band. Ann Neurol 1978;4(2):124–9. DOI: 10.1002/ana.410040206. PMID: 707983.Gilliatt R.W., Willison R.G., Dietz V., Williams I.R. Peripheral nerve conduction in patients with a cervical rib and band. Ann Neurol 1978;4(2):124–9. DOI: 10.1002/ana.410040206. PMID: 707983.38. Passero S., Paradiso C., Giannini F. et al. Diagnosis of thoracic outlet syndrome. Relative value of electrophysiological studies. Acta Neurol Scand 1994;90(3):179–85. PMID: 7847058.Passero S., Paradiso C., Giannini F. et al. Diagnosis of thoracic outlet syndrome. Relative value of electrophysiological studies. Acta Neurol Scand 1994;90(3):179–85. PMID: 7847058.39. Veilleux M., Stevens J.C., Campbell J.K. Somatosensory evoked potentials: lack of value for diagnosis of thoracic outlet syndrome. Muscle Nerve 1988;11(6): 571–5. DOI: 10.1002/mus.880110608. PMID: 3386665.Veilleux M., Stevens J.C., Campbell J.K. Somatosensory evoked potentials: lack of value for diagnosis of thoracic outlet syndrome. Muscle Nerve 1988;11(6): 571–5. DOI: 10.1002/mus.880110608. PMID: 3386665.40. Kothari M.J., Macintosh K., Heistand M., Logigian E.L. Medial antebrachial cutaneous sensory studies in the evaluation of neurogenic thoracic outlet syndrome. Muscle Nerve 1998;21(5):647–9. PMID: 9572246.Kothari M.J., Macintosh K., Heistand M., Logigian E.L. Medial antebrachial cutaneous sensory studies in the evaluation of neurogenic thoracic outlet syndrome. Muscle Nerve 1998;21(5):647–9. PMID: 9572246.41. Seror P. Medial antebrachial cutaneous nerve conduction study, a new tool to demonstrate mild lower brachial plexus lesions. A report of 16 cases. Clin Neurophysiol 2004;115(10):2316–22. DOI: 10.1016/j.clinph.2004.04.023. PMID: 15351373.Seror P. Medial antebrachial cutaneous nerve conduction study, a new tool to demonstrate mild lower brachial plexus lesions. A report of 16 cases. Clin Neurophysiol 2004;115(10):2316–22. DOI: 10.1016/j.clinph.2004.04.023. PMID: 15351373.42. Felice K.J., Butler K.B., Druckemiller W.H. Cervical root stimulation in a case of classic neurogenic thoracic outlet syndrome. Muscle Nerve 1999;22(9):1287–92. PMID: 10454729.Felice K.J., Butler K.B., Druckemiller W.H. Cervical root stimulation in a case of classic neurogenic thoracic outlet syndrome. Muscle Nerve 1999;22(9):1287–92. PMID: 10454729.43. Tolson T.D. “EMG” for thoracic outlet syndrome. Hand Clin 2004;20(1):37–42. DOI: 10.1016/S0749-0712(03)00089-1. PMID: 15005382.Tolson T.D. “EMG” for thoracic outlet syndrome. Hand Clin 2004;20(1):37–42. DOI: 10.1016/S0749-0712(03)00089-1. PMID: 15005382.44. Boulanger X., Ledoux J.B., Brun A.L., Beigelman C. Imaging of the non-traumatic brachial plexus. Diagn Interv Imaging 2013;94(10):945–56. DOI: 10.1016/j.diii.2013.06.015. PMID: 23891030.Boulanger X., Ledoux J.B., Brun A.L., Beigelman C. Imaging of the non-traumatic brachial plexus. Diagn Interv Imaging 2013;94(10):945–56. DOI: 10.1016/j.diii.2013.06.015. PMID: 23891030.45. Sureka J., Cherian R.A., Alexander M., Thomas B.P. MRI of brachial plexopathies. Clin Radiol 2009;64(2):208–18. DOI: 10.1016/j.crad.2008.08.011. PMID: 19103352.Sureka J., Cherian R.A., Alexander M., Thomas B.P. MRI of brachial plexopathies. Clin Radiol 2009;64(2):208–18. DOI: 10.1016/j.crad.2008.08.011. PMID: 19103352.46. Demondion X., Herbinet P., Van Sint Jan S. et al. Imaging assessment of thoracic outlet syndrome. Radiographics 2006;26(6):1735–50. DOI: 10.1148/rg.266055079. PMID: 17102047.Demondion X., Herbinet P., Van Sint Jan S. et al. Imaging assessment of thoracic outlet syndrome. Radiographics 2006;26(6):1735–50. DOI: 10.1148/rg.266055079. PMID: 17102047.47. Raptis C.A., Sridhar S., Thompson R.W. et al. Imaging of the patient with thoracic outlet syndrome. Radiographics 2016;36(4):984–1000. DOI: 10.1148/rg.2016150221. PMID: 27257767.Raptis C.A., Sridhar S., Thompson R.W. et al. Imaging of the patient with thoracic outlet syndrome. Radiographics 2016;36(4):984–1000. DOI: 10.1148/rg.2016150221. PMID: 27257767.48. Demirbag D., Unlu E., Ozdemir F. et al. The relationship between magnetic resonance imaging findings and postural maneuver and physical examination tests in patients with thoracic outlet syndrome: results of a double-blind, controlled study. Arch Phys Med Rehabil 2007;88(7):844–51. DOI: 10.1016/j.apmr.2007.03.015. PMID: 17601463.Demirbag D., Unlu E., Ozdemir F. et al. The relationship between magnetic resonance imaging findings and postural maneuver and physical examination tests in patients with thoracic outlet syndrome: results of a double-blind, controlled study. Arch Phys Med Rehabil 2007;88(7):844–51. DOI: 10.1016/j.apmr.2007.03.015. PMID: 17601463.49. Moriarty J.M., Bandyk D.F., Broderick D.F. et al. ACR appropriateness criteria imaging in the diagnosis of thoracic outlet syndrome. J Am Coll Radiol 2015;12(5): 438–43. DOI: 10.1016/j.jacr.2015.01.016. PMID: 25824254.Moriarty J.M., Bandyk D.F., Broderick D.F. et al. ACR appropriateness criteria imaging in the diagnosis of thoracic outlet syndrome. J Am Coll Radiol 2015;12(5): 438–43. DOI: 10.1016/j.jacr.2015.01.016. PMID: 25824254.50. Singh V.K., Jeyaseelan L., Kyriacou S. et al. Diagnostic value of magnetic resonance imaging in thoracic outlet syndrome. J Orthop Surg (Hong Kong). 2014;22(2):228– 31. DOI: 10.1177/230949901402200224. PMID: 25163962.Singh V.K., Jeyaseelan L., Kyriacou S. et al. Diagnostic value of magnetic resonance imaging in thoracic outlet syndrome. J Orthop Surg (Hong Kong). 2014;22(2):228– 31. DOI: 10.1177/230949901402200224. PMID: 25163962.51. Chang K.V., Lin C.P., Lin C.S. et al. Sonographic tracking of trunk nerves: essential for ultrasound-guided pain management and research. J Pain Res 2017;10:79–88. DOI: 10.2147/JPR.S123828. PMID: 28115867.Chang K.V., Lin C.P., Lin C.S. et al. Sonographic tracking of trunk nerves: essential for ultrasound-guided pain management and research. J Pain Res 2017;10:79–88. DOI: 10.2147/JPR.S123828. PMID: 28115867.52. Fried S.M., Nazarian L.N. Dynamic neuromusculoskeletal ultrasound documentation of brachial plexus/thoracic outlet compression during elevated arm stress testing. Hand (N Y) 2013;8(3):358–65. DOI: 10.1007/s11552-013-9523-8. PMID: 24426950.Fried S.M., Nazarian L.N. Dynamic neuromusculoskeletal ultrasound documentation of brachial plexus/thoracic outlet compression during elevated arm stress testing. Hand (N Y) 2013;8(3):358–65. DOI: 10.1007/s11552-013-9523-8. PMID: 24426950.53. Aranyi Z., Csillik A., Bohm J., Schelle T. Ultrasonographic identification of fibromuscular bands associated with neurogenic thoracic outlet syndrome: the “wedgesickle” sign. Ultrasound Med Biol 2016;42(10):2357–66. DOI: 10.1016/j.ultrasmedbio.2016.06.005. PMID: 27444863.Aranyi Z., Csillik A., Bohm J., Schelle T. Ultrasonographic identification of fibromuscular bands associated with neurogenic thoracic outlet syndrome: the “wedgesickle” sign. Ultrasound Med Biol 2016;42(10):2357–66. DOI: 10.1016/j.ultrasmedbio.2016.06.005. PMID: 27444863.54. Braun R.M., Sahadevan D.C., Feinstein J. Confirmatory needle placement technique for scalene muscle block in the diagnosis of thoracic outlet syndrome. Tech Hand Up Extrem Surg 2006;10(3):173–6. DOI: 10.1097/01.bth.0000231967.74041.48. PMID: 16974223.Braun R.M., Sahadevan D.C., Feinstein J. Confirmatory needle placement technique for scalene muscle block in the diagnosis of thoracic outlet syndrome. Tech Hand Up Extrem Surg 2006;10(3):173–6. DOI: 10.1097/01.bth.0000231967.74041.48. PMID: 16974223.55. Torriani M., Gupta R., Donahue D.M. Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using an ultrasound-guided approach. Skeletal Radiol 2010;39(10):973–80. DOI: 10.1007/s00256-010-0897-1. PMID: 20186413.Torriani M., Gupta R., Donahue D.M. Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using an ultrasound-guided approach. Skeletal Radiol 2010;39(10):973–80. DOI: 10.1007/s00256-010-0897-1. PMID: 20186413.56. Wilbourn A.J. 10 most commonly asked questions about thoracic outlet syndrome. Neurologist 2001;7(5):309–12. PMID: 14649631.Wilbourn A.J. 10 most commonly asked questions about thoracic outlet syndrome. Neurologist 2001;7(5):309–12. PMID: 14649631.