Thoracic outlet syndrome (TOS) consists of upper limb neurological and vascular symptoms due to compression of the neurovascular bundle as it passes through the thoracic outlet1. Compression may occur within the interscalene space, the costoclavicular space and the recto-pectoralis minor space however is most common within the costoclavicular space and is exacerbated by abduction of the arm which further narrows this space2. The aetiology of neurogenic thoracic outlet syndrome is thought to most likely be due to hyperextension neck injury (which may be minor) in...

Our imaging protocol is performed on a 3 Tesla platform with sequences consisting of 3D SPACE STIR images in a coronal plane orientated to the neurovascular bundle, sagittal Dixon T2 images and T1 weighted images with the imaged volume extending through the supraclavicular fossa to the humerus. Sequences are performed with the arm in both neutral position and in abduction with external rotation. Additionally, a sagittal T2 cervical spine is performed to assess cervical nerve roots. We present five patients who were imaged with the...

Case 1:A 23-year-old male office worker with long term clinical picture in keeping with neurogenic thoracic outlet syndrome, including pain, dysesthesia, and reduced power in the left upper limb, worsened with the arm positioned overhead. Subtle muscle wasting was present to supraspinatus, deltoid and abductor digiti minimi muscles. Roos test was positive. MR (sagittal T1) demonstrated reduction of the costoclavicular space with dynamic manoeuvres from 27mm to 7mm resulting in bony compression of the brachial plexus within the costoclavicular space. Contour abnormality of the plexus...

Neurogenic thoracic outlet syndrome is challenging diagnosis with delayed diagnosis leading to poorer outcomes4. In our experience, imaging the brachial plexus with an MR protocol with dynamic maneuvers can serve as a valuable tool in the diagnostic pathway and surgical planning of patients with clinical features in keeping with neurogenic thoracic outlet syndrome, allowing demonstration of compression of the plexus within the narrowed costoclavicular space. This case series presented demonstrates a selection of patients with favourable outcomes following surgical release of such compression.

Klaassen Z, Sorenson E, Tubbs RS, Arya R, Meloy P, Shah R, Shirk S, Loukas M. Thoracic outlet syndrome: a neurological and vascular disorder. Clin Anat. 2014 Jul;27(5):724-32. doi: 10.1002/ca.22271. Epub 2013 May 29. PMID: 23716186. Aralasmak A, Cevikol C, Karaali K, Senol U, Sharifov R, Kilicarslan R, Alkan A. MRI findings in thoracic outlet syndrome. Skeletal Radiol. 2012 Nov;41(11):1365-74. doi: 10.1007/s00256-012-1485-3. Epub 2012 Jul 11. PMID: 22782291. K.A. Illig et al. (eds.), Thoracic Outlet Syndrome DOI 10.1007/978-1-4471-4366-6_7, © Springer-Verlag London 2013 Magill ST, Brus-Ramer...