Estudo por imagem da síndrome do desfiladeiro torácico

Abstract

INTRODUÇÃOO desfiladeiro torácico consiste em dois espaços anatômicos:1. Espaço do triângulo interescaleno: compreende o espaço entre o músculo escaleno anterior (anteriormente), músculos escalenos médio e posterior (posteriormente) e pela primeira costela (inferiormente). O tronco superior do plexo braquial (raízes C5 e C6) e o tronco médio (raiz C7) ocupam a porção superior deste espaço. O tronco inferior (raízes C8 e T1) ocupa a parte inferior, posteriormente à artéria subclávia. A artéria subclávia situa-se na margem inferior deste espaço.2. Espaço costoclavicular: delimitado pela metade medial da clavícula (superiormente), pela face cranial da primeira costela (inferiormente), pelo ligamento costoclavicular ou rombóide (anteriormente) e pelo músculo escaleno posterior (posteriormente).O plexo braquial é formado pela união dos ramos ventrais das raízes C5 a C8 e a maior parte do ramo ventral de T1. Os ramos ventrais de C5 e C6 se unem para formar o tronco superior. O ramo ventral de C7 continua como tronco médio, e os ramos ventrais de C8 e T1 juntam-se para formar o tronco inferior. Cada um dos três troncos se divide em anterior e posterior. As divisões posteriores unem-se para formar o fascículo posterior. Já as divisões anteriores dos troncos superior e médio juntam-se para formar o fascículo lateral, e a divisão anterior do tronco inferior prossegue como fascículo medial.O termo síndrome do desfiladeiro torácico (SDT) foi utilizado pela primeira vez por Peet et al (1)

Identification of diagnostic maneuvers positive for arterial compression in symptomatic or asymptomatic individuals who engage in regular weight training

“…Published studies that have investigated the pectoralis minor syndrome by screening with the hyperabduction or Wright maneuvers have reported it as a rare form of compression; however, in this study it was the most commonly detected maneuver of those investigated. 2,3 People who trained their upper limbs (arm and forearm)more than other muscle groups most often exhibited a positive M2 (Adson) maneuver. Muscular hypertrophy is one possible explanation for the presence of compression.…”

“…Muscular hypertrophy is one possible explanation for the presence of compression. 1,2 The results for the costoclavicular (M3) maneuver showed that age was the only variable associated and the mean age of people with compression was greater than the mean age of people free from the condition. This can be explained by lowering of the pectoral girdle due to hypotonia of the suspending muscles: the trapezius, levator scapelae and rhomboid, that can take place during the aging process.…”

“…Thoracic Outlet Syndrome (TOS) and Popliteal Artery Entrapment Syndrome (PAES) are conditions in which extrinsic compression of arteries is caused by anatomic variants, muscular hypertrophy or postural abnormalities. 1,2 As a result of the population's growing tendency to frequent gyms and engage in weight training and resistance exercises, muscular hypertrophy is not just inevitable, but is often the desired result. Irrespective of whether there are also anatomic variants present, muscular hypertrophy can result in the phenomenon of vessel compression, with the possibility of risk of vascular complications.…”

“…The presence of normal arterial pulses at rest does not rule out the existence of arterial compression; which is why it is important to conduct diagnostic maneuvers to identify compression with a view to prevention of complications. [1][2][3] The maneuvers used to detect the arterial compressions involved in TOS are the Hyperabduction maneuver, or Wright's test, (subcoracoid tunnel or retropectoralis space), the Adson test (interscalene triangle) and the Costoclavicular interval maneuver (between the clavicle and the first rib); however, none of these tests have been accepted as the gold standard for diagnosis and they offer 53% mean specificity and 72% mean sensitivity. [2][3][4] Although patients with positive maneuver results do not always develop the disease, it is believed that for the syndrome to occur, in addition to the anatomic narrowing, some degree of repetitive trauma is also required for the symptoms to develop and this may occur during regular exercise at gyms.…”

“…[1][2][3] The maneuvers used to detect the arterial compressions involved in TOS are the Hyperabduction maneuver, or Wright's test, (subcoracoid tunnel or retropectoralis space), the Adson test (interscalene triangle) and the Costoclavicular interval maneuver (between the clavicle and the first rib); however, none of these tests have been accepted as the gold standard for diagnosis and they offer 53% mean specificity and 72% mean sensitivity. [2][3][4] Although patients with positive maneuver results do not always develop the disease, it is believed that for the syndrome to occur, in addition to the anatomic narrowing, some degree of repetitive trauma is also required for the symptoms to develop and this may occur during regular exercise at gyms. 3,4 In the lower limbs, PAES may be the result of anatomic variants in arterial and/or venous trajectories, of abnormal insertion of the gastrocnemius muscles into the medial condyle of the femur, or of muscular hypertrophy (the functional form).…”