{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:41:26Z","timestamp":1790862086150,"version":"4.1.0"},"reference-count":79,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Neurogenic thoracic outlet syndrome (nTOS) can present itself in a number of ways, often resulting in diagnostic ambiguity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To establish a consensus among upper extremity experts using the Delphi method to determine the most clinically relevant criteria in distinguishing nTOS to help create a diagnostic algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Consensus statement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A panel of 20 upper extremity experts rated the importance of 54 different clinical items in reference to distinguishing nTOS. Items were ranked on a scale from 0 (least important) to 10 (most important). The mean and standard deviation for each item\u2019s rankings were calculated. The Cronbach alpha (\u03b1) value was used to determine the degree of concordance among the panelists\u2019 rankings. Analogous items with similarly high rankings were combined to help develop the final criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A Cronbach \u03b1 value of .936 was calculated, indicating a high degree of consensus among the experts\u2019 responses. Similar items with higher rankings were combined to help develop the final criteria. The 5 criteria deemed clinically important for nTOS were (1) a positive response to injections (pectoralis minor, anterior scalene, middle scalene); (2) upper or lower trunk radiating symptoms that worsen with supraclavicular provocative maneuvers (scalene pressure or positive Tinel sign over scalenes); (3) upper or lower trunk symptoms that worsen with infraclavicular provocative maneuvers (positive Tinel sign medial to coracoid or tenderness to palpation over the coracoid process); (4) reproduction of pain with 90\u00b0 of abduction in external rotation or upper limb tension test, and (5) participation in work\/exercise requiring repetitive arm stress (overhead athletes, throwing sports, protracted posture at work, etc).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study proposed 5 clinical criteria for distinguishing nTOS that were agreed upon by 20 upper extremity, nerve, and vascular surgery experts. These criteria can be used to develop a future diagnostic algorithm for nTOS, allowing for further research and more efficient nTOS treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671261440925","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T21:11:41Z","timestamp":1779225101000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Defining Diagnostic Criteria for Neurogenic Thoracic Outlet Syndrome: An Expert Consensus"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9241-5702","authenticated-orcid":false,"given":"Eric R.","family":"Wagner","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance M.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Medical College of Georgia, Augusta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9496-1805","authenticated-orcid":false,"given":"Kevin R.","family":"Cuneo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9246-854X","authenticated-orcid":false,"given":"Krishna N.","family":"Chopra","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwakorede","family":"Omole","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Gottschalk","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6549-090X","authenticated-orcid":false,"given":"Robert L.","family":"Bowers","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"issue":"6","key":"e_1_3_3_2_2","first-page":"687","article-title":"Surgical treatment for symptoms produced by cervical ribs and the scalenus anticus muscle","volume":"85","author":"Adson AW","year":"1947","unstructured":"Adson AW. Surgical treatment for symptoms produced by cervical ribs and the scalenus anticus muscle. Surg Gynecol Obstet. 1947;85(6):687-700.","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xrrt.2022.05.008"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsg.2022.07.004"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aanat.2023.152046"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2017.09.002"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvscit.2024.101508"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2015-209583"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semvascsurg.2024.01.005"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2008.2723"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2005.35.4.227"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516665801"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diii.2013.06.015"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0712(03)00080-5"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0712(03)00112-4"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(03)00389-X"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02421379"},{"key":"e_1_3_3_18_2","article-title":"Anatomy, thorax, subclavian veins","author":"Capobianco SM","year":"2025","unstructured":"Capobianco SM, Fahmy MW, Sicari V. Anatomy, thorax, subclavian veins. StatPearls; 2025.","journal-title":"StatPearls"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.08.110"},{"issue":"8","key":"e_1_3_3_20_2","article-title":"Consensus recommendations for neurogenic thoracic outlet syndrome from the INTOS Workgroup","volume":"12","author":"Chim H","year":"2024","unstructured":"Chim H, Hagan RR. Consensus recommendations for neurogenic thoracic outlet syndrome from the INTOS Workgroup. Plast Reconstr Surg Glob Open. 2024;12(8):e6107.","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2023.05.014"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-198908000-00010"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thorsurg.2020.09.007"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2009.070128"},{"issue":"2","key":"e_1_3_3_25_2","first-page":"149","article-title":"Surgical anatomy of the subclavian artery and its branches","volume":"108","author":"Daseler EH","year":"1959","unstructured":"Daseler EH, Anson BJ. Surgical anatomy of the subclavian artery and its branches. Surg Gynecol Obstet. 1959;108(2):149-174.","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1148\/rg.266055079"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2021.10.046"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0004-9514(14)60655-3"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0034-7094(12)70108-3"},{"issue":"4","key":"e_1_3_3_30_2","first-page":"311","article-title":"Thoracic outlet syndrome of pectoralis minor etiology mimicking cardiac symptoms on activity: a case report","volume":"56","author":"Fitzgerald G","year":"2012","unstructured":"Fitzgerald G. Thoracic outlet syndrome of pectoralis minor etiology mimicking cardiac symptoms on activity: a case report. J Can Chiropr Assoc. 2012;56(4):311-315.","journal-title":"J Can Chiropr Assoc"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2022.01.133"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2006.03.005"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(03)00211-7"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-0138.22"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2016.05.047"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thorsurg.2020.09.001"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.882184"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40122-019-0124-2"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1007\/s100169900150"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jseint.2023.12.001"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465980260022801"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2012.01.013"},{"issue":"2","key":"e_1_3_3_43_2","first-page":"67","article-title":"False positive rate of thoracic outlet syndrome diagnostic maneuvers","volume":"48","author":"Nord KM","year":"2008","unstructured":"Nord KM, Kapoor P, Fisher J, et al. False positive rate of thoracic outlet syndrome diagnostic maneuvers. Electromyogr Clin Neurophysiol. 2008;48(2):67-74.","journal-title":"Electromyogr Clin Neurophysiol"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.2174\/1874325001711010140"},{"key":"e_1_3_3_45_2","first-page":"135","volume-title":"The Measurement of Health and Health Status","author":"Krabbe PFM","unstructured":"Krabbe PFM. Concepts, methods and applications from a multidisciplinary perspective. In: The Measurement of Health and Health Status. Academic Press; 2017:135-150."},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-13-00215"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2010.12.003"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10926-010-9278-9"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-005-0191-x"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0712(03)00088-X"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10050962"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000687"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2011.11.132"},{"issue":"10","key":"e_1_3_3_54_2","first-page":"15","article-title":"Delayed diagnosis of Paget-Schroetter syndrome in a patient with COVID-19","volume":"104","author":"Maxwell M","year":"2021","unstructured":"Maxwell M, Ebadi F, Hogan E. Delayed diagnosis of Paget-Schroetter syndrome in a patient with COVID-19. R I Med J (2013). 2021;104(10):15-17.","journal-title":"R I Med J (2013)"},{"issue":"1","key":"e_1_3_3_55_2","first-page":"46","article-title":"Bilateral thoracic outlet syndrome misdiagnosed as a connective tissue disorder","volume":"63","author":"Mishra DK","year":"2015","unstructured":"Mishra DK, Kalmath BC, Rathod KK, et al. Bilateral thoracic outlet syndrome misdiagnosed as a connective tissue disorder. J Assoc Physicians India. 2015;63(1):46-47.","journal-title":"J Assoc Physicians India"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2014.02.015"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.10192"},{"issue":"2","key":"e_1_3_3_58_2","first-page":"67","article-title":"False positive rate of thoracic outlet syndrome diagnostic maneuvers","volume":"48","author":"Nord KM","year":"2008","unstructured":"Nord KM, Kapoor P, Fisher J, et al. False positive rate of thoracic outlet syndrome diagnostic maneuvers. Electromyogr Clin Neurophysiol. 2008;48(2):67-74.","journal-title":"Electromyogr Clin Neurophysiol"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-43.6.565"},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2016.07.065"},{"issue":"3","key":"e_1_3_3_61_2","article-title":"Reliability and validity of the standardized elevated arm stress test in the diagnosis of neurogenic thoracic outlet syndrome","volume":"76","author":"Pesser N","year":"2022","unstructured":"Pesser N, de Bruijn BI, Goeteyn J, et al. Reliability and validity of the standardized elevated arm stress test in the diagnosis of neurogenic thoracic outlet syndrome. J Vasc Surg. 2022;76(3):821-829 e821.","journal-title":"J Vasc Surg"},{"key":"e_1_3_3_62_2","article-title":"Anatomy, thorax, subclavian arteries","author":"Rahimi O","year":"2025","unstructured":"Rahimi O, Geiger Z. Anatomy, thorax, subclavian arteries. StatPearls; 2025.","journal-title":"StatPearls"},{"key":"e_1_3_3_63_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2009.11.010"},{"key":"e_1_3_3_64_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.math.2013.05.010"},{"key":"e_1_3_3_65_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2012-008131"},{"key":"e_1_3_3_66_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199901)22:1<126::AID-MUS21>3.0.CO;2-S"},{"key":"e_1_3_3_67_2","doi-asserted-by":"publisher","DOI":"10.1186\/2047-783X-14-10-443"},{"issue":"3","key":"e_1_3_3_68_2","article-title":"Pectoralis minor syndrome: subclavicular brachial plexus compression","volume":"7","author":"Sanders RJ","year":"2017","unstructured":"Sanders RJ, Annest SJ. Pectoralis minor syndrome: subclavicular brachial plexus compression. Diagnostics (Basel). 2017;7(3).","journal-title":"Diagnostics (Basel)"},{"key":"e_1_3_3_69_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semvascsurg.2015.02.001"},{"key":"e_1_3_3_70_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2007.04.050"},{"key":"e_1_3_3_71_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.01031"},{"key":"e_1_3_3_72_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2011.10.011"},{"key":"e_1_3_3_73_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1198165"},{"key":"e_1_3_3_74_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2022.08.019"},{"key":"e_1_3_3_75_2","doi-asserted-by":"publisher","DOI":"10.1620\/tjem.205.19"},{"key":"e_1_3_3_76_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-47.2.149"},{"key":"e_1_3_3_77_2","first-page":"587","article-title":"The scapula: the greater masquerader of shoulder pathologies","volume":"73","author":"Wagner ER","year":"2024","unstructured":"Wagner ER, Hussain ZB, Karzon AL, et al. The scapula: the greater masquerader of shoulder pathologies. Instr Course Lect. 2024;73:587-607.","journal-title":"Instr Course Lect"},{"key":"e_1_3_3_78_2","first-page":"609","article-title":"Scapular dyskinesia: how to differentiate between etiologies","volume":"73","author":"Wagner ER","year":"2024","unstructured":"Wagner ER, Karzon AL, Hussain ZB, et al. Scapular dyskinesia: how to differentiate between etiologies. Instr Course Lect. 2024;73:609-624.","journal-title":"Instr Course Lect"},{"key":"e_1_3_3_79_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.OA.24.00203"},{"key":"e_1_3_3_80_2","doi-asserted-by":"publisher","DOI":"10.5535\/arm.2013.37.6.896"}],"container-title":["Orthopaedic Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671261440925","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23259671261440925","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671261440925","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T21:16:13Z","timestamp":1779398173000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23259671261440925"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":79,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/23259671261440925"],"URL":"https:\/\/doi.org\/10.1177\/23259671261440925","relation":{},"ISSN":["2325-9671","2325-9671"],"issn-type":[{"value":"2325-9671","type":"print"},{"value":"2325-9671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"article-number":"23259671261440925"}}