Diagnostic Accuracy of Clinical Tests for Neurogenic and Vascular Thoracic Outlet Syndrome: A Systematic Review

Abstract

Objective: To summarize the evidence on the accuracy of clinical tests to help confirm or refute a diagnosis of thoracic outlet syndrome (TOS).

Methods: We searched 10 databases (January 1990 to February 2016) using relevant key words and medical subject headings terms. We considered diagnostic test accuracy studies comparing clinical tests for the diagnosis of TOS against a reference test. Cross-sectional, cohort, and case-control studies and randomized controlled trials were included. Risk of bias was appraised using QUADAS-2 and the Quality Appraisal of Reliability Studies checklist. We performed a qualitative synthesis of scientifically admissible studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used to report findings.

Results: A total of 3932 articles were retrieved. After removal of duplicates, 1767 articles were screened for titles and abstract, leaving 494 articles for full-text review. Ten studies met the eligibility criteria and were assessed for risk of bias, 4 of which were included in the review. None of the included studies used the same index tests when comparing with a gold standard, and quality was poor. High clinical heterogeneity and the use of different comparators prevented from pooling results. Findings suggest that prescribing magnetic resonance imaging during provocative positioning to confirm a diagnosis of TOS may be useful. However, this is associated with a high false-positive rate of venous compression.

Conclusion: Little evidence currently supports the validity of clinical tests for the diagnosis of TOS. Future diagnostic accuracy studies should aim to use established methodological criteria and appropriate reporting guidelines to help validate clinical tests for diagnosing patients with TOS.

Keywords: Diagnosis; Diagnostic Imaging; Physical Examination; Thoracic Outlet Syndrome.