Differential Diagnosis of Neurogenic Thoracic Outlet Syndrome: A Review

Thoracic outlet syndrome (TOS) is a complex and often overlooked condition caused by the compression of neurovascular structures as they pass through the thoracic outlet. This compression can result in pain, numbness, tingling, muscle weakness, and vascular complications, with severe cases leading to thrombosis or embolism. TOS is classified into three types based on the affected structure: neurogenic, venous, and arterial. Neurogenic TOS is the most prevalent, accounting for over 90% of cases, and is more commonly seen in females. Venous TOS represents 3–5% of cases, while arterial TOS is the rarest, comprising only 1%. Diagnosing TOS is challenging due to its symptom overlap with various musculoskeletal and neurological disorders, often leading to misdiagnosis. The absence of universally accepted diagnostic criteria further complicates identification, relying primarily on clinical evaluations and inconsistent diagnostic methods. Neurogenic TOS, in particular, is difficult to distinguish from other conditions with similar presentations. This study provides a comprehensive review of the differential diagnosis of neurogenic TOS, comparing it with musculoskeletal and neurological disorders that share overlapping clinical features.