Prädiktoren für das Vorliegen eines Thoracic Outlet Syndrom

Stegemann, Jan Ole

Thesis

Open Access

Prädiktoren für das Vorliegen eines Thoracic Outlet Syndrom

Files

Primary djos.pdf (8.97 MB)

Date

2026-03-16

Authors

Stegemann, Jan Ole

Supervisors

Person

Parahuleva, Mariana

Abstract

Analysing data from 994 TOS patients who presented at the TOS Centre of AGAPLESION DIAKONIE KLINIKEN KASSEL for further workup of suspected thoracic outlet syndrome (TOS) between 2013 and 2022, we were able to identify several predictors for the presence of TOS. Unfortunately, we were unable to identify any universally applicable predictors for the presence of TOS that could be determined without inpatient contact. A history of deep arm vein thrombosis is the only good/reliable predictor for the presence of TOS and vTOS in this study. Overall, the composition of our patient group was consistent with that described in the literature (predominantly female, average age approx. 37 years). However, the distribution of TOS subtypes in our cohort differed markedly from previously published cohorts. This is likely due to the vascular focus of our interdisciplinary TOS centre, where the proportion of vascular TOS - and aTOS in particular - was considerably higher than that reported in the literature The main finding of our analysis is that a thorough medical history and physical examination remain central to the diagnosis of TOS. TOS-specific provocation manoeuvres are particularly useful in the initial diagnostic workup when nTOS is suspected, and to a lesser extent in aTOS. Their diagnostic value depends heavily on correct execution by experienced personnel. Instrumental diagnostics also play an important role in the evaluation of TOS. In our analysis, sonography, angiography, and finger oscillography in resting and provocation positions proved particularly valuable. Because of its retrospective design, this study is limited to parameters documented in standard medical histories, physical and instrumental examinations. Consequently, questions that emerged in the context of this thesis but were not part of the documented data could not be addressed. In addition, some data were incomplete due to variations in the quality of documentation in the patient records. Because TOS often presents with unspecific symptoms, final diagnosis is frequently delayed, sometimes by several years requiring multiple physician consultations. Future research should therefore focus on evaluating low-threshold examination methods and targeted questions in the medical history of TOS patients. This could support the development of effective early detection strategies and enable high-risk patients to undergo specific diagnostic workup at an earlier stage. The role of diagnostic imaging - particularly non-invasive and low-radiation modalities such as sonography - should also be further explored, as TOS patients are typically young and unnecessary radiation exposure should be avoided.