Relationships between the Clinical Test Results and Neurophysiological Findings in Patients with Thoracic Outlet Syndrome

Abstract

A thoracic outlet syndrome (TOS) is the type of brachial plexus disorder most difficult to objectively assess using a clinical examination and differential diagnosis. Its symptoms can be frequently misdiagnosed, especially among others with cervical disc-root conflicts, plexopathies, and peripheral neuropathies. In this study, we aim to identify the correlations between positive Doppler ultrasonography results indicating pathological changes in the subclavian flow velocity, clinical tests, and chosen clinical neurophysiology recordings as proposed alternative or supplementary diagnostic tools for evaluating TOS patients. Sixty TOS patients with positive Doppler ultrasonography and Roos test results and sixty healthy people as a control group were bilaterally examined, and the results were compared. Pain intensity was assessed using a visual analogue scale (VAS). Sensory perceptions within C4–C8 dermatomes were assessed with Von Frey filament (FvF) tests. The activity of motor units in the proximal and distal muscles of the upper extremities was evaluated using surface electromyography (sEMG) during maximal contractions before and after a provocative raised hands test (RHT). An electroneurography (ENG) was used to evaluate the transmission of nerve impulses peripherally. Motor evoked potential (MEP) recordings, induced by the over-vertebral magnetic stimulation of the C5–C7 neuromeres, were used to examine motor transmissions from the cervical motor centres to the upper extremities muscles. The results revealed a relationship between positive Doppler test scores and pathological changes in the subclavian flow velocity through the results of the following diagnostic tools: a VAS score of 1.9 was detected on average, superficial sensory perception abnormalities were found in the innervation areas of the ulnar nerves detected by FvF tests, a decrease in the amplitudes of sEMG recordings was seen in distal rather than proximal muscles (especially following the RHT), a decrease in the motor and sensory peripheral transmissions of nerve impulses in the median, ulnar and cutaneous anterobrachial median nerves was seen, as well as MEP amplitudes recorded from the abductor pollicis brevis muscle. The provocative RHT combined with sEMG and MEP recordings can be considered accurate and objective clinical neurophysiology tools that could supplement the commonly used clinical tests. Such an approach may result in a more precise neurogenic TOS diagnostic algorithm.

The Usefulness of Motor Potentials Evoked Transvertebrally at Lumbar Levels for the Evaluation of Peroneal Nerve Regeneration after Experimental Repair in Rats

“…This may be of particular importance in the case of damage to the brachial plexus in its proximal part [ 23 ]. The available data from the literature on the use of magnetic stimulation in the assessment of the proximal nerve part of the upper extremity mostly relate to neurological disorders such as motor neuron disease, neurogenic thoracic outlet syndrome, chronic inflammatory demyelinating polyneuropathy, and Guillain–Barré–Strohl syndrome [ 24 ].…”

Clinical Neurophysiological Methods Verify Improvement in the Motor Neural Transmission in Patients with Surgically Treated Idiopathic Scoliosis in Long-Term Follow-up

“…The Guidelines of the International Federation of Clinical Neurophysiology-The European Chapter [29][30][31] were followed during the mcsEMG recordings' acquisition and interpretation. The patients attempted three maximal muscle contractions for 5 s. The neurophysiologist selected the best recording with the highest mean amplitude measured peak to peak concerning the isoelectric line for analysis.…”

Unveiling the Correlations between Clinical Assessment of Spasticity and Muscle Strength and Neurophysiological Testing of Muscle Activity in Incomplete Spinal Cord Injury Patients: The Importance of a Comprehensive Evaluation

“…These tests took place in a temperature-controlled room maintained at an average of 22 • C. For sEMG measurements, we employed standard disposable Ag/AgCl surface recording electrodes with an active surface area of 5 mm 2 . The active electrode was positioned on the muscle belly, the reference electrode on the distal tendon of the same muscle, and the ground electrode on the distal part of the examined muscle, following the Guidelines of the International Federation of Clinical Neurophysiology-European Chapter [34,35]. The recording system was configured with upper and lower filters set at 10 kHz and 20 Hz, respectively.…”