Clinical case of a patient with Thoracic outlet syndrome
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Thoracic outlet syndrome
Raynaud's disease
May-Thurner syndrome

How to Cite

Dimova, Z., Boyadzhieva, V., Emin, S., & Stoilov, N. (2023). Clinical case of a patient with Thoracic outlet syndrome. Rheumatology (Bulgaria), 30(4), 65-73.


Thoracic outlet syndrome (TOS) is a group of conditions that result in compression of the brachial plexus, causing symptoms of pain, muscle weakness, and numbness in the shoulders and upper extremities. The classification of TOS is based on pathophysiological symptoms and is mainly divided into neurogenic (nTOS), venous (vTOS) and arterial (aTOS). Depending on the etiology, TOC can be classified as congenital, traumatic, or functionally acquired.

We present a clinical case of a 34-year-old man who was admitted to the Rheumatology Clinic, UMBAL "St. Ivan Rilski" in July 2022. The patient reports complaints of numbness in the fingers, weakness of the upper extremities when the arms are raised, and periungual bruising. The patient underwent phlebography in 2021, with the conclusion of compression of v.subclavia dextra et sinistra during abduction and ipsilateral rotation of the head. From the performed CT-angiography, compression of the right common iliac artery on the left common iliac vein was found, which was dilated, corresponding to the highest degree with May-Turner syndrome. In the rheumatology clinic, capillaroscopy was performed, which visualized peripheral vascular spasm and nonspecific changes. Laboratory and immunological tests did not reveal any abnormalities.
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    1. Aljabri B, Al-Omran M. Surgical management of vascular thoracic outlet syndrome: a teaching hospital experience. Ann Vasc Dis. 2013;6(1):74–79.
    2. Roquelaure Y, Descatha A. Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact. J Occup Rehabil. 2011;21(3):366–373.
    3. Freischlag J, Orion K. Understanding thoracic outlet syndrome. Scientifica (Cairo). 2014;2014:1–6
    4. Citisli V. Assessment of diagnosis and treatment of thoracic outlet syndrome, an important reason of pain in upper extremity, based on literature. J Pain Relief. 2015;04(02):1–7.
    5. Maru S, Dosluoglu H, Dryjski M, Cherr G, Curl GR, Harris LM. Thoracic outlet syndrome in children and young adults. Eur J Vasc Endovasc Surg. 2009;38(5):560–564.
    6. Brooke BS, Freischlag JA. Contemporary management of thoracic outlet syndrome. Curr Opin Cardiol. 2010;25(6):535–540
    7. Rutherford RB. Vascular Surgery. 6th ed. Saunders; 2005.
    8. Hooper TL, Denton J, McGalliard MK, Brismée J-M, Sizer PS. Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis. J Man Manip Ther. 2010;18(2):74–83.
    9. Demondion X, Herbinet P, Van Sint Jan S, Boutry N, Chantelot C, Cotten A. Imaging assessment of thoracic outlet syndrome. RadioGraphics. 2006;26(6):1735–1750.
    10. Thompson RW. Comprehensive management of subclavian vein effort thrombosis. Semin Intervent Radiol. 2012;29(1):44–51.
    11. Cooke RA. Thoracic outlet syndrome–aspects of diagnosis in the differential diagnosis of hand-arm vibration syndrome. Occup Med (Lond). 2003;53(5):331–6.
    12. Ingegnoli F, Gualtierotti R, Orenti A, et al. Uniphasic blanching of the fingers, abnormal capillaroscopy in nonsymptomatic digits, and autoantibodies: expanding options to increase the level of suspicion of connective tissue diseases beyond the classification of Raynaud’s phenomenon. J Immunol Res. 2015;2015:371960.
    13. Duwayri YM, Emery VB, Driskill MR, et al. Positional compression of the axillary artery causing upper extremity thrombosis and embolism in the elite overhead throwing athlete. J Vasc Surg. 2011;53(5):1329–1340.
    14. Kuhn JE, Lebus GF, Bible JE. Thoracic outlet syndrome. J Am Acad Orthop Surg. 2015;23(4):222–232.
    15. Duarte FH, Zerati AE, Gornati VC, Nomura C, Puech-Leão P. Normal Costoclavicular Distance as a Standard in the Radiological Evaluation of Thoracic Outlet Syndrome in the Costoclavicular Space. Ann Vasc Surg. 2021 Apr;72:138-146.
    16. Vos CG, Ünlü Ç, Voûte MT, et al. Thoracic outlet syndrome: first rib resection. Shanghai Chest 2017;1:3.
    17. Povlsen S, Povlsen B. GThoracic outlet syndrome: a hard problem in diagnosis and management. Shanghai Chest 2017;1:59;
    18. Poyyamoli S, Mehta P, Cherian M, Anand RR, Patil SB, Kalva S, Salazar G. May-Thurner syndrome. Cardiovasc Diagn Ther. 2021 Oct;11(5):1104-1111. doi: 10.21037/cdt.2020.03.07. PMID: 34815961; PMCID: PMC8569277.
    19. Sheth RN, Campbell JN. Surgical treatment of thoracic outlet syndrome: a randomized trial comparing two operations. J Neurosurg Spine 2005;3:355-63
    20. Finlayson HC, O'Connor RJ, Brasher PM, et al. Botulinum toxin injection for management of thoracic outlet syndrome: a double-blind, randomized, controlled trial. Pain 2011;152:2023-8.
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