Interdisziplinarität, Evidenz und Relevanz der Klassifizierung in der Behandlung des Thoracic-Outlet-Syndroms

Zusammenfassung

Das Thoracic-Outlet-Syndrom (TOS) beschreibt die Kompression der neurovaskulären Strukturen des thorakalen Ausgangs. Es wird mit einer Inzidenz von 2–3 pro 100000 Personen pro Jahr bemessen. Die Patienten sind häufig durch Schmerzen und/oder Funktionsausfälle beeinträchtigt. Verschiedene Fachdisziplinen sind an Diagnostik und Behandlung beteiligt. Die Diagnosestellung ist primär klinisch und unter Ausschluss von Differenzialdiagnosen zu stellen. Apparative Zusatzdiagnostik in Form z. B. eines Ultraschalls, MRTs, einer Angiografie oder einer Elektroneurografie (ENG) kann hier unterstützen. Es existieren, je nach behandelnder Fachrichtung, verschiedene Klassifikationen und Behandlungsstrategien. Die Studienlage in Form von qualitativ hochwertigen Studien zur Behandlung ist limitiert, hat sich aber in den vergangenen Jahren verbessert. Bislang wurden keine einheitlichen, fächerübergreifenden Leitlinien zur Diagnose und Behandlung des Thoracic-Outlet-Syndroms erstellt.

Abstract

Thoracic Outlet Syndrome (TOS) refers to the compression of the neurovascular structures at the thoracic outlet. Its incidence is estimated at 2–3 cases per 100000 individuals per year. Patients are frequently affected by pain and/or functional impairment. The diagnostic and therapeutic process typically involves multiple medical specialties. Diagnosis is primarily clinical and requires the exclusion of differential diagnoses. Additional diagnostic modalities, such as ultrasound, MRI, angiography, or electroneurography, may provide supportive information. Depending on the treating discipline, different classifications and therapeutic strategies are applied. The availability of high-quality studies on treatment remains limited, although evidence has improved in recent years. To date, no standardised, interdisciplinary guidelines for the diagnosis and management of Thoracic Outlet Syndrome have been established.

Schlüsselwörter

Thoraxchirurgie - Thoracic-Outlet-Syndrom - Kompressionssyndrom

Keywords

compression syndrome - thoracic surgery - thoracic outlet syndrome

Publication History

Received: 15 August 2025

Accepted after revision: 28 October 2025

Article published online:
18 December 2025

• Literatur

• 1 Ferrante MA. The thoracic outlet syndromes. Muscle Nerve 2012; 45: 780-795
• 2 Illig KA, Rodriguez-Zoppi E, Bland T. et al. The incidence of thoracic outlet syndrome. Ann Vasc Surg 2021; 70: 263-272
• 3 Bürger T. Deutsche Gesellschaft für Gefäßchirurgie (DGG). Leitlinie zum Thoracic Outlet Syndrom. 2008 Accessed November 03, 2025 at: https://www.diako-kassel.de/fileadmin/Agaplesion_dkk-kassel/Dateien/Gefaess_Leitlinie_zum_TOS.pdf
• 4 Dorn P, Zehnder A, Kocher GJ. [Thoracic Outlet Syndrome: Rare, Often Missed or Over-Diagnosed?. ] Praxis (Bern 1994) 2021; 110: 391-396
• 5 Wilbourn AJ. Thoracic outlet syndrome is overdiagnosed. Muscle Nerve 1999; 22: 130-136
• 6 Roos DB. Thoracic outlet syndrome is underdiagnosed. Muscle Nerve 1999; 22: 126-129
• 7 Illig KA, Donahue D, Duncan A. et al. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. J Vasc Surg 2016; 64: e23-e35
• 8 Dengler NF, Ferraresi S, Rochkind S. et al. Thoracic Outlet Syndrome Part I: Systematic Review of the Literature and Consensus on Anatomy, Diagnosis, and Classification of Thoracic Outlet Syndrome by the European Association of Neurosurgical Societies’ Section of Peripheral Nerve Surgery. Neurosurgery 2022; 90: 653-667
• 9 Rochkind S, Ferraresi S, Denisova N. et al. Thoracic Outlet Syndrome Part II: Consensus on the Management of Neurogenic Thoracic Outlet Syndrome by the European Association of Neurosurgical Societies’ Section of Peripheral Nerve Surgery. Neurosurgery 2023; 92: 251-257
• 10 Chim H, Hagan RR. Consensus Recommendations for Neurogenic Thoracic Outlet Syndrome from the INTOS Workgroup. Plast Reconstr Surg Glob Open 2024; 12: e6107
• 11 Dengler NF, Pedro MT, Kretschmer T. et al. Neurogenic Thoracic Outlet Syndrome-Presentation, Diagnosis, and Treatment. Dtsch Arztebl Int 2022; 119: 735-742
• 12 Ferrante MA, Ferrante ND. The thoracic outlet syndromes: Part 2. The arterial, venous, neurovascular, and disputed thoracic outlet syndromes. Muscle Nerve 2017; 56: 663-673
• 13 Nejim B, Alshaikh HN, Arhuidese I. et al. Perioperative Outcomes of Thoracic Outlet Syndrome Surgical Repair in a Nationally Validated Database. Angiology 2017; 68: 502-507
• 14 Peek J, Vos CG, Ünlü Ç. et al. Outcome of Surgical Treatment for Thoracic Outlet Syndrome: Systematic Review and Meta-Analysis. Ann Vasc Surg 2017; 40: 303-326
• 15 Desai SS, Toliyat M, Dua A. et al. Outcomes of surgical paraclavicular thoracic outlet decompression. Ann Vasc Surg 2014; 28: 457-464
• 16 Likes K, Rochlin DH, Call D. et al. Coexistence of arterial compression in patients with neurogenic thoracic outlet syndrome. JAMA Surg 2014; 149: 1240-1243
• 17 Archie M, Rigberg D. Vascular TOS-Creating a Protocol and Sticking to It. Diagnostics (Basel) 2017; 7: 34
• 18 Henry BM, Vikse J, Sanna B. et al. Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations. World Neurosurg 2018; 110: e965-e978
• 19 Vögelin E, Haldemann L, Constantinescu MA. et al. Long-term outcome analysis of the supraclavicular surgical release for the treatment of thoracic outlet syndrome. Neurosurgery 2010; 66: 1085-1091 discussion 1091–1092
• 20 Morel J, Pirvu A, Elie A. et al. Functional Results of Cervical Rib Resection for Thoracic Outlet Syndrome: Impact on Professional Activity. Ann Vasc Surg 2019; 56: 233-239
• 21 Goeteyn J, Pesser N, Houterman S. et al. Surgery Versus Continued Conservative Treatment for neurogenic Thoracic Outlet Syndrome: the First Randomised Clinical Trial (STOPNTOS Trial). Eur J Vasc Endovasc Surg 2022; 64: 119-127
• 22 Kakamad FH. To resect or avulse first rib in management of neurogenic thoracic outlet syndrome: a randomized controlled trial. Updates Surg 2025; 77: 947-952
• 23 Woodworth TT, Le A, Miller C. et al. Botulinum toxin injections for the treatment of neurogenic thoracic outlet syndrome: A systematic review. Muscle Nerve 2024; 70: 28-35