Diagnosis of thoracic outlet syndrome in the emergency department

The use of the emergency department (ED) as a source for primary care has increased the number of patients seen in this setting with even chronic symptoms such as pain, paresthesias, and weakness in the upper extremity. This group may include individuals with thoracic outlet syndrome (TOS). We were concerned that TOS may be underdiagnosed in the ED because of physician unfamiliarity with the signs and symptoms of TOS. Hence, we retrospectively studied cases of TOS seen at the ED of the University hospital during a 29-year period. We believe this is the first report in the English language literature to reflect the assessment and management of TOS in the ED. The study data include clinical presentation, diagnostic tests, and management of TOS. Lack of thorough evaluation resulted in underdiagnosis of TOS in our ED. We recommend that ED personnel pay close attention to patients with symptoms of long duration and that ED physicians be aware of TOS presentation and its management.