Neurogenic thoracic outlet syndrome (nTOS)

Neurogenic thoracic outlet syndrome (nTOS) is one of the most controversial nerve compression syndromes. Especially for the subgroup of atypical nTOS no clear diagnostic criteria are defined. The aim of this article is to illustrate the relevant literature with respect to diagnostic criteria, differential diagnosis and therapeutic options for nTOS. Despite a vast number of retrospective and case studies there is very low quality evidence regarding nTOS. There is a lack of generally accepted diagnostic criteria for nTOS and particularly atypical nTOS. In addition long-term follow-up studies and studies of the natural course of nTOS are sparse. According to the current literature the level of evidence for nTOS is low. Diagnosis should be made restrictively, especially when objectifiable neurological symptoms are lacking. Recently developed imaging modalities, such as magnetic resonance (MR) neurography might be able to objectify the diagnosis of nTOS. Conservative treatment is considered to be the basic therapy of nTOS. Surgical treatment with restricted medical indications has led to an improvement of symptoms in approximately 80 % of patients and approximately 62 % of patients were free of complaints.