Thoracic outlet syndrome--aspects of diagnosis in the differential diagnosis of hand-arm vibration syndrome

BACKGROUND: Thoracic outlet syndrome (TOS) is a cause of vascular and neurological compromise to the arm and hand, and may manifest as Raynaud's phenomenon. It may be under-diagnosed. AIM: This review was undertaken in order to clarify the diagnostic and investigative features of TOS that may differentiate it from hand-arm vibration syndrome. METHODS: A tiered review of the world literature was undertaken using Medline and Embase as the primary search engines. CONCLUSION: Thoracic outlet syndrome most commonly presents with neurological symptoms in the arm. Vascular symptoms, including Raynaud's phenomenon, may occur in approximately 10% of cases. Careful clinical assessment by history and examination may reveal the elements of forearm and upper arm symptoms with postural exacerbation, which distinguish this condition from hand-arm vibration syndrome. The usefulness of investigation is unclear, but Doppler and neuroelectric studies may be valuable. Magnetic resonance imaging scan is the investigation of choice.