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 similar to10% 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.