Rare etiologies of thoracic outlet syndrome: A systematic review

Kakamad,Fahmi H.; Ghafour,Abdullah K.; Nasralla,Hawkar A.; Asaad,Saywan Kakarash; Sabr,Nsren S.; Tahir,Soran H.; Namiq,Hiwa Shafiq; Mustafa,Lawen J.; Abbas,Yadgar N.; Abdalla,Berun A.; Omer,Choman Sabah; Ahmed,Ahmed H.; Hattam,Azad Star; Sharif,Lawand Ahmed

doi:10.3892/wasj.2025.383

Rare etiologies of thoracic outlet syndrome: A systematic review

Authors:
- Fahmi H. Kakamad
- Abdullah K. Ghafour
- Hawkar A. Nasralla
- Saywan Kakarash Asaad
- Nsren S. Sabr
- Soran H. Tahir
- Hiwa Shafiq Namiq
- Lawen J. Mustafa
- Yadgar N. Abbas
- Berun A. Abdalla
- Choman Sabah Omer
- Ahmed H. Ahmed
- Azad Star Hattam
- Lawand Ahmed Sharif
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Affiliations: College of Medicine, University of Sulaimani, Sulaymaniyah 46001, Iraq, Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah 46001, Iraq
Published online on: August 4, 2025 https://doi.org/10.3892/wasj.2025.383
Article Number: 95
Copyright : © Kakamad et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

Thoracic outlet syndrome (TOS) encompasses a group of symptoms resulting from the compression of neurovascular structures within the thoracic outlet. While TOS is often linked to repetitive activities, trauma, or anatomical variations, rare causes can also play a critical role in this condition. The present study systematically explored these unusual etiologies of TOS. A comprehensive search was conducted using PubMed and Google Scholar databases to identify relevant studies in the English language on rare causes of TOS. Studies addressing well‑recognized causes were excluded. Data extracted from the selected studies included the authors, year of publication, number of cases, patient demographics, history of trauma or TOS, symptoms, affected side, Roos test results, misdiagnoses, the underlying cause of TOS, the type of TOS, diagnostic approach, management strategies, outcomes, follow‑up details and recurrence rates. The main findings were summarized using means, ranges, frequencies and percentages. A total of 246 articles were screened, and 30 case reports involving 30 patients met the inclusion criteria. The mean age of the patients in the studies was 40.83±16.93 years, with 18 males (60%) and 12 females (40%). Neurogenic TOS was identified in 17 cases (56.67%), followed by neurovascular TOS in 8 cases (26.67%), venous TOS in 3 cases (10.00%) and arterial TOS in 2 cases (6.67%). Rare causes included clavicular fracture screws, subclavius posticus muscle, osteoblastoma, lipoma, Nuss procedure, chondrosarcoma and several other unusual conditions. The complexity and variability of rare causes of TOS underscore the importance of precise diagnostic evaluation. Recognizing these rare etiologies is essential for reducing misdiagnosis and improving patient outcomes through targeted diagnostic and treatment strategies.

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