Coexistence of arterial compression in patients with neurogenic thoracic outlet syndrome (original) (raw)
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Surgical Updates on Thoracic Outlet Syndrome
Current Surgery Reports, 2016
Purpose of Review Thoracic outlet syndrome is a widely recognized, yet highly disputed, syndrome mostly affecting structures of the thoracic outlet, including the brachial plexus, subclavian artery, and subclavian vein. Surgical decompression in the form of first rib resection with scalenectomy remains the mainstay of treatment particularly for venous and arterial thoracic outlet syndrome. This review serves as an update of recent publications/updates in the literature. Recent Findings Approaches to operative management continue to evolve as minimally invasive techniques have increased in popularity. Diagnostic techniques continue to evolve, particularly with regard to neurogenic thoracic outlet syndrome, to allow for more timely and accurate diagnosis. Conservative management strategies, such as anterior scalene muscle blocks, are utilized with increasing frequency, although their long-term outcomes remain unclear. Summary The aim of the present work is to review updates in the diagnosis and management of thoracic outlet syndrome over the last decade, and discuss utility and outcomes of various strategies.
Clinical Study Early versus Late Surgical Treatment for Neurogenic Thoracic Outlet Syndrome
2015
Jasem Yousef Al-Hashel, Ashraf Ali M. A. El Shorbgy, Samar Farouk Ahmed, and Rawhia R. Elshereef 1 Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, Safat 13115, Kuwait 2 Department of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait 3 Department of Cardiothoracic Surgery, Minia University, P.O. Box 61519, Minia 61111, Egypt 4Department of Neurology and Psychiatry, Minia University, P.O. Box 61519, Minia 61111, Egypt 5 Department of Rheumatology, Minia University, P.O. Box 61519, Minia 61111, Egypt
Arterial complications of the thoracic outlet syndrome
European Journal of Vascular and Endovascular Surgery, 1995
Objectives: Arterial complications due to compression of the thoracic outlet are uncommon. The objective of this study was to review our fairly extensive experience with this problem with particular reference to its management. Methods: Patients entered into the Vascular Clinic database were reviewed over an 11 year period. Twenty six records were found. In 24 patients the vasculopathy was caused by a cervical rib (complete in 15) and in two by an anomaly of the first rib. In all patients the basic arteriopathy was a fibrous structure with a post-stenotic aneurysm in 13. Seventeen presented with a fixed pulse deficit; 13 had a palpable aneurysm and 12 had distal embolisation. Results: Two patients refused operation. In 22 with cervical rib, the rib was removed via a supraclavicular incision, an anterior scalenectomy was performed and the arterial pathology repaired on its merit, usually by vein graft replacement or bypass. In two with first rib anomalies these were resected by the transaxillary route. Twenty three patients have been followed for between 3 months and 10 years; 20 are cured and three have residual claudication. Conclusions: Our results show that simple excision of the cervical rib via the supraclavicular route together with vascular reconstruction is adequate. This is in disagreement with the view of those who advocate routine excision of the first rib in addition to cervical rib excision.
Surgical treatment of thoracic outlet syndrome : immediate and mid-term results
2008
Introduction: We report the results from a consecutive series of patients treated by scalenectomy or cervical rib resection for clearly symptomatic or paucisymptomatic thoracic outlet syndrome (TOS) over a 6-year period. Material and methods: From September 1999 to August 2005, 14 surgical decompressions were performed in 12 patients with unremitting signs and symptoms of nerve or vascular compression at the thoracic outlet. The symptoms of TOS were due to involvement of the brachial plexus in 8 cases (57.1%). A sign of vascular obstruction could be detected in 10 cases (71.4%): in 6 cases (42.8%) the presentation was predominantly arterial (arm claudication, coldness, Raynaud’s phenomenon and distal embolisation) and in 4 cases (28.5%) was related to vein compression with congestion and swelling of the affected arm or vein thrombosis. Two patients presented as emergencies with critical upper limb ischaemia or distal vessel embolisation. Results: The median follow-up period was 28.2...
Conservative Treatment of Thoracic Outlet Syndrome: A Narrative Review
International journal of Pain
INTRODUCTION Thoracic Outlet Syndrome (TOS) is a group of disorders that results in compression of the brachial plexus and subclavian axillary vessels in the area of the thoracic outlet [1]. The structures involved in TOS include the clavicle, first rib, and scalene muscles. TOS occurs in three spaces: the intercostal-scalene triangle, costoclavicular space, and coracopectoral space [2]. Peer et al. first proposed the term TOS in 1956 to summarize symptoms caused by compression of the neurovascular bundle [3], and the disease was termed "TOS" by Rob and Standeven in 1958 [4]. TOS occurs more frequently in women than in men and develops in patients in their third or fifth decades of life [5]. TOS is usually classified into neurogenic, arterial, and venous TOS [6]. Common causes of TOS are congenital, acquired, or traumatic. It can be further divided into arterial vascular, venous vascular, true neurologic, traumatic neurovascular, and disputed types [7].
Neurogenic Thoracic Outlet Syndrome Reviewed
Albanian Journal of Trauma and Emergency Surgery
Neurogenic Thoracic Outlet Syndrome (NTOS) is a rare, but controversial syndrome in relation to its diagnosis, treatment modality, and approaches in case of surgical treatment. In the English literature, there are sparse studies dealing with these aspects. We conducted a PubMed 2000-2017 literature review and found a total of 3953 cases reported with NTOS. The clinical characteristics, etiology, electrophysiological and radiological work-up and treatment options were reviewed and reported. It seems that, as far as surgical indication criteria are concerned, there is a consensus for NTOS in its motor deficit stage and its techniques are generally well established. This review showed that differential diagnosis, radiological, and electrophysiological criteria for correct diagnosis of NTOS are not controversial. However, surgical indications and types of approaches and techniques reflect the surgeon’s affiliation with specialties dealing with NTOS (vascular, plastic, hand, orthopedic o...
Journal of Manual & Manipulative Therapy, 2010
Thoracic outlet syndrome (TOS) is a frequently overlooked peripheral nerve compression or tension event that creates difficulties for the clinician regarding diagnosis and management. Investigators have categorized this condition as vascular versus neurogenic, where vascular TOS can be subcategorized as either arterial or venous and neurogenic TOS can subcategorized as either true or disputed. The thoracic outlet anatomical container presents with several key regional components, each capable of compromising the neurovascular structures coursing within. Bony and soft tissue abnormalities, along with mechanical dysfunctions, may contribute to neurovascular compromise. Diagnosing TOS can be challenging because the symptoms vary greatly amongst patients with the disorder, thus lending to other conditions including a double crush syndrome. A careful history and thorough clinical examination are the most important components in establishing the diagnosis of TOS. Specific clinical tests, whose accuracy has been documented, can be used to support a clinical diagnosis, especially when a cluster of positive tests are witnessed.
Early versus Late Surgical Treatment for Neurogenic Thoracic Outlet Syndrome
ISRN Neurology, 2013
Objectives. To compare the outcome of early surgical intervention versus late surgical treatment in cases of neurogenic thoracic outlet syndrome (NTOS). Design. Prospective study. Settings. Secondary care (Al-Minia University Hospital, Egypt) from 2007 to 2010. Participants. Thirty-five patients of NTOS (25 women and 10 men, aged 20–52 years), were classified into 2 groups. First group (20 patients) was operated within 3 months of the onset and the second group (15 patients) was operated 6 months after physiotherapy. Interventions. All patients were operated via supraclavicular surgical approach. Outcomes Measures. Both groups were evaluated clinically and, neurophysiologically and answered the disabilities of the arm, shoulder, and hand (DASH) questionnaire preoperatively and 6 months after the surgery. Results. Paraesthesia, pain, and sensory nerve action potential (SNAP) of ulnar nerve were significantly improved in group one. Muscle weakness and denervation in electromyography E...
Proposed Pathogenesis for a Subgroup of Patients with Neurogenic Thoracic Outlet Syndrome
Journal of Clinical Surgery and Research
Most patients with Neurogenic Thoracic Outlet Syndrome (TOS) have upper extremity pain and paresthesia with normal neurologic examination and objective tests. The purpose of this study was to determine the pathologic nature of the resected first ribs in a subgroup of patients TOS who experienced resolution of symptoms postoperatively. Methods: In a retrospective study, we compared normal human cadaver first ribs (control, C) with first ribs from patients with proven NTOS (N). Ribs were examined for anatomic features. Preoperative and postoperative dynamic Magnetic Resonance Angiograms (MRA) of the affected and contralateral upper extremities were examined. Results: There were 41 first ribs from patients with DNTOS and 12 normal first ribs from human cadavers. In all patients (100%) with DNTOS there was a bony tubercle which corresponded to the area of subclavian vein groove in the normal ribs. Conclusion: A bony tubercle at the site of the subclavian vein groove in patients with DNT...