Neurogenic thoracic outlet syndrome: a review of diagnostic and therapeutic strategies

The diagnosis and treatment of neurogenic thoracic outlet syndrome (nTOS) remain challenging. Although consensus-based clinical frameworks exist, they lack robust externa validation. This study conducts a review of nTOS publications in the PubMed, Embase, and Web of Science databases, with a search cutoff date of December 2025. Current evidence suggests that the incidence of nTOS may be underestimated. Diagnosis should be based on a comprehensive evaluation, including medical history, systematic physical examination, ancillary examinations, diagnostic muscle block, and exclusion of other possible diseases. Treatment should be carried out in a phased manner. For mild cases, nonsurgical treatment is preferred. For patients who experience progressive neurological dysfunction, muscle atrophy, or failure of conservative treatment, timely surgery should be considered. Surgical decompression mainly involves the supraclavicular or axillary approaches. Surgical techniques include first rib resection, rib-sparing scalenectomy, pectoralis minor release, cervical rib resection. However, the optimal treatment remains controversial due to the limited availability of high-quality evidence. Future research should focus on elucidating the pathophysiology of nTOS, improving diagnostic accuracy through technological innovation, and optimizing treatment protocols through prospective multicenter studies.