![]() The road to correct diagnosis and appropriate treatment is often long. In everyday clinical practice, there is much uncertainty about the presentation, proper diagnostic evaluation, characterization, and treatment of nTOS. The Society for Vascular Surgery, when it proposed the adoption of the uniform classifying standard in 2016, explicitly advised against the use of the term dTOS ( 2). Some authors also describe a further type called “disputed” thoracic outlet syndrome (dTOS), which is characterized by inconsistent symptoms ( 1). The numbers are thought to be much higher in athletes, particularly in sports involving intense use of the upper limbs, such as swimming, rowing, or volleyball ( 11, 12). An analysis in the United States in 2021 yielded an estimated incidence of 2–3 cases and an estimated prevalence of approximately 10 cases per 100 000 persons per year ( 5, 10). The accurate determination of the incidence and prevalence of nTOS presents a methodological challenge. The percentage of women among nTOS patients ranged from 59% to 95% ( 6, 8, 9). ( 5) 82–85% of patients who underwent TOS surgery and whose TOS was classified by the uniform standards of the Society for Vascular Surgery had nTOS ( 6, 7). ![]() In large case series from the USA, for example, in a prospective analysis of outpatient cases at the University of South Florida, the percentage of nTOS was 82%. Yet the more recent international literature, based on the uniform classification of the Society for Vascular Surgery (in the USA), reveals a trend toward recognition of primary nTOS as the most common type of TOS ( 2). V., DGG) (an update was due in 2010, but did not appear no update is now planned, according to a reply from the DGG to an inquiry on May 23, 2022) ( 3, 4). In German-speaking countries, the literature in current journals and textbooks focuses on aTOS, as does the S2 guideline of the German Society for Vascular Surgery and Vascular Medicine ( Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin e. The classic distinction is between arterial (aTOS), venous (vTOS), and neurogenic thoracic outlet syndrome (nTOS) ( 2). There are a variety of causes for compression of, and damage to, these structures ( 1). One or more anatomic structures of the upper thoracic outlet may be affected (the brachial plexus, the subclavian artery, and/or the subclavian vein ). Thoracic outlet syndrome (TOS) is a heterogeneous group of disorders characterized by compression of, and/or damage to, the neurovascular structures at the thoracic outlet, i.e., the passage from the chest into the neck. The deadline for submission is 27 October 2023. Participation in the CME certification program is possible only over the internet:. This article has been certified by the North Rhine Academy for Continuing Medical Education.
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