Title: Thoracic outlet syndrome: an update on diagnostic imaging development and application for a challenging clinical entity

Biography:

Sebastian Povlsen is a Medical Doctor at King’s College Hospital NHS Foundation Trust in London. He obtained his Bachelor’s degree from the University of Oxford with a focus on Neuroscience in 2014. He graduated as Doctor from Imperial College School of Medicine in 2017, obtaining his MBBS with Distinction. He is a peer reviewer for a reputable journal and has published more than 5 papers in reputable journals, with review articles on thoracic outlet syndrome including publication by the Cochrane Collaboration.

Abstract

Shoulder pain is common in the general population, and thoracic outlet syndrome (TOS) is a well-recognised, yet controversial, diagnosis that causes pain, sensory disturbance and sometimes even weakness in the neck and upper extremity. It results from compression of the neurovascular bundle at the transition point between the base of the neck and the thorax at the level of the first rib. There are multiple factors that predispose to its development, including anatomical variants and repetitive overhead upper limb exertion. The nature of the patient’s presentation depends on which structure is implicated (vein, artery or brachial plexus) and the aetiology of compression or damage. The wide variety presentations of the same clinical entity have historically placed a larger focus on history taking and clinical examination over diagnostic imaging, but this lack of imaging poses a problem to both diagnosis and subsequent management. The challenges in this area have been well documented the Society for Vascular Surgery and the Cochrane Collaboration. These challenges are especially true of neurogenic TOS, which represents over 90% of TOS cases. However, the field of diagnostic imaging is ever-changing, with developments and new applications of dynamic CT angiography, brachial plexus ultrasound, magnetic resonance neurography and diffusion tensor imaging producing exciting new findings, which could shift the role that medical imaging plays in this controversial condition. Here we aim to discuss these most exciting recent developments and discuss future directions in the field.