Diagnosis of neurogenic thoracic outlet syndrome: 2016 consensus guidelines and other strategies

The diagnosis of neurogenic thoracic outlet syndrome (TOS) depends upon clinical suspicion, pattern-recognition, and exclusion of more common conditions that have overlapping features. In most patients a diagnosis of neurogenic TOS can be made or excluded on the basis of the clinical history, description of symptoms, and physical examination. The clinical diagnosis may then be supported, clarified, or challenged by a limited number of adjunctive diagnostic studies. In this chapter the clinical diagnosis of neurogenic TOS is described along with the development of consensus-based clinical diagnostic criteria for this condition by the Consortium for Outcomes Research and Education on Thoracic Outlet Syndrome (CORE-TOS) and the Society for Vascular Surgery (SVS) committee on reporting standards for TOS. Application of these diagnostic criteria in a prospective, observational, cohort study is illustrated. Broader use of these diagnostic criteria will be a valuable step toward achieving more consistent clinical care and improved comparative effectiveness research for neurogenic TOS.