Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients

Gillard, J.; Pérez-Cousin, M; Hachulla, É.; Rémy, Jacques; Hurtevent, Jean-François; Vinckier, L.; Thévenon, A.; Duquesnoy, B

doi:10.1016/s1297-319x(01)00298-6

Cited by 164 publications

(93 citation statements)

References 16 publications

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“…It is postulated that combining the results of more than one test may increase specificity. This was investigated by Gillard et al (2001) in the assessment of subclavian artery compression. Gillard et al (2001) recommended a minimum of two provocative arm manoeuvres to increase specificity.…”

Section: Discussionmentioning

confidence: 99%

“…This was investigated by Gillard et al (2001) in the assessment of subclavian artery compression. Gillard et al (2001) recommended a minimum of two provocative arm manoeuvres to increase specificity. The results of the present study reinforce the lack of specificity of one individual test and the necessity to integrate all information from a clinical assessment (i.e., clinical presentation, subjective history, physical examination, special tests, imaging results) to reduce the occurrence of misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of vascular compression syndromes affecting the upper limb come under the 'umbrella term' of thoracic outlet syndrome with most published reports focusing on the more commonly compressed subclavian artery, vein or surrounding neural structures (Demondion, Herbinet, Gautier, Duquesnoy, & Cotton, 2006;Gillard et al, 2001). Descriptions of the syndrome inconsistently include compression of the first and second portions of the axillary artery in the costoclavicular and retro-pectoralis minor space, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Sonographic evaluation of the axillary artery during simulated overhead throwing arm positions

Stapleton

Herrington

George

2008

Physical Therapy in Sport

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Objectives: The aim of this study was to determine changes in axillary artery diameter and peak systolic velocity in asymptomatic individuals during upper limb positioning commonly used to assess vascular pathology in athletes. Design: Repeated measures observational study. Setting: Physiology laboratory. Participants: Subjective and objective screening excluded individuals with past, or present, conditions related to neurovascular compression syndromes. Thirty-one subjects (21 females, 10 males; mean age: 2574 years) were included in the final analysis. Main outcome measures: Sonographically determined axillary artery diameter and peak systolic velocity, as well as symptom production, were recorded for a series of 12 randomised arm positions, incorporating varying degrees of abduction, external rotation, and horizontal flexion/extension. Results: The majority of arm positions revealed no change in artery diameter and peak systolic velocity. However, at the extreme of abduction, and arm positions incorporating 1201 abduction, significant (po0.0005) reductions in axillary artery diameter were noted. All mean results masked wide heterogeneity: 13% demonstrating a greater than 50% reduction in diameter, 10%, a doubling of peak systolic velocity, and 42%, reporting symptoms. Conclusions: The number of individual clinically ''positive'' responses questions the specificity of individual diagnostic tests, such as the hyperabduction manoeuvre, and highlights the need to interpret test results in conjunction with the subjective assessment and other physical findings from the objective assessment. r

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sonographic evaluation of the axillary artery during simulated overhead throwing arm positions

Stapleton

Herrington

George

2008

Physical Therapy in Sport

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“…Die diagnostischen Kriterien für eine arterielle Kompression sind der Nach weis einer funktionellen Obstruktion der A. subclavia oder der Nachweis einer Gefäßwandalteration (siehe nachstehende Tabelle und Abbildung (Gillard et al 2001;Longley et al 1992). Die Sen sitivität wird nicht beeinflusst.…”

Section: Die Bedeutung Der Duplexsonographie Bei Der Diagnose Des Tosunclassified

“…Die Sensitivität und Spezifität der CTA in der Beurteilung von Stenosen der Arteria axillaris beträgt 68 % bis 76 % bzw. 82 % bis 100 % (Bilbey et al 1989;Gillard et al 2001;Remy Jardin et al 2000b). Hierbei wurde gezeigt, dass die höchste Sensitivität und Spezifität durch Be trachtung der volumengerenderten Rekonstruktionen erreicht wurden (Remy Jardin et al 2000b).…”

Section: Die Bedeutung Der Duplexsonographie Bei Der Diagnose Des Tosunclassified

Thoracic-Outlet-Syndrom (TOS)

Buckup¹,

Buckup²

2012

Klinische Tests an Knochen, Gelenken Und Muskeln

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Clinical Update: Thoracic Outlet Syndrome

Brigham¹,

Brooks²,

Talmage³

2004

AMA Guides® Newsletter

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The diagnosis, cause, and treatment of thoracic outlet syndrome (TOS) are challenging, and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) gives no specific instructions about rating impairments associated with this disorder. TOS is a group of symptoms and signs, including pain, weakness, paresthesias, numbness, swelling, and/or coldness arising at the base of the neck or superior chest but involving the upper limbs. Causes include compression of the brachial plexus (neurogenic TOS) or, less frequently, subclavian vein and/or artery (vascular TOS). Provocative tests for TOS attempt to induce symptoms and/or signs by compressing the subclavian artery or vein or brachial plexus, but palpitation of the radial pulse in various extremity positions is of limited diagnostic value. Diagnostic studies may include radiographs of the cervical spine, upper chest, and/or shoulder; MRI scans of the thoracic outlet; arteriography or venography, and electrodiagnostic testing. The differential diagnosis for TOS is broad and includes cervical radiculopathy, superior sulcus tumor, other peripheral nerve entrapment syndromes, complex regional pain syndrome, and psychiatric disease. The evaluator must determine if the symptoms, physical findings, and diagnostic study results support the diagnosis; the report should list the rating options considered, discuss the rationale for selecting the method(s) used, and explain how the percentage was calculated.

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Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients

Cited by 164 publications

References 16 publications

Sonographic evaluation of the axillary artery during simulated overhead throwing arm positions

Sonographic evaluation of the axillary artery during simulated overhead throwing arm positions

Thoracic-Outlet-Syndrom (TOS)

Clinical Update: Thoracic Outlet Syndrome

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