The Gilliatt-Sumner hand: a diagnostic clue of neurogenic thoracic outlet syndrome

Matsubara, Tomoyasu; Kurokawa, K; Sakurai, Keita; Yasutomi, H; Yamawaki, Takemori

doi:10.1093/qjmed/hcy122

Cited by 8 publications

(4 citation statements)

References 5 publications

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“…Remarkably, in accordance with the reporting standards of the Society of Vascular Surgery [3], only vascular CS are considered when it comes to classifying patients into different TOS sub-groups. This is likely inadequate as CS can affect veins (Paget Schroetter syndrome) or arteries (sub-clavicular aneurysm or ischemia from distal emboli) but also nerves (amyotrophy and abnormal nerve conduction at rest, specifically of C8 or T1 roots) [15][16][17]. Further, it is currently difficult to provide clinical proof of ischemia or arm swelling.…”

Section: New Paradigm For Clinical Classificationmentioning

confidence: 99%

New Paradigms for Thoracic Outlet Compression and Thoracic Outlet Syndrome, with or without Complications or Sequelae: A Trans-Continental and Trans-Disciplinary Opinion Paper

Abraham,

Wennberg,

Bauer

et al. 2023

JVD

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The anatomy of the human shoulder predisposes the neurovascular bundle to compression at different levels of the thoracic outlet during abduction of the arm. There are four possible levels of compression at the thoracic outlet pathway: at the costo-clavicular angle, the inter-scalenic angle, under the pectoralis minor muscle or at the level of the humeral head. The positional thoracic outlet compression (TOC) often remains completely asymptomatic. When symptomatic, compressions are collectively referred to as thoracic outlet syndrome (TOS) and may require surgery if physical therapy fails to improve symptoms. The “thoracic outlet compression with complications or sequelae” (the acronym of which is “TOC-CS”, which can be simplified as “TOX”) will almost invariably lead to surgery to release the compression, and other possible treatment targeting the complications as required. There is a continuum between TOC, TOS and TOX, which are simply different clinical stages of the same mechanical issue, just like the Rutherford grades represent different stages of lower extremity arterial disease. We believe that discriminating between TOC, TOS and TOX clarifies clinical definitions and their respective treatment options. TOC is to be considered as a physiological positional phenomenon, TOS requires medical or surgical treatment and surgery should be considered as a primary option in TOX.

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Section: New Paradigm For Clinical Classificationmentioning

confidence: 99%

New Paradigms for Thoracic Outlet Compression and Thoracic Outlet Syndrome, with or without Complications or Sequelae: A Trans-Continental and Trans-Disciplinary Opinion Paper

Abraham,

Wennberg,

Bauer

et al. 2023

JVD

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“…Upper plexus (C5‐C7) involvement may present with weakness of the deltoid, biceps, and brachialis muscles whereas lower plexus (C8‐T1) involvement should be suspected with weakness of wrist and finger flexors 22 . Advanced cases may even exhibit Gilliatt‐Sumner hand, with signs of denervation and atrophy of the abductor pollicis brevis, hypothenar, and interossei muscles (Level V) 23 . It is also important to perform neurological testing, such as upper extremity reflexes, assessing for Hoffman's sign and Spurling's test, which if positive, would suggest more proximal disease at the nerve roots or cervical spinal cord.…”

Section: Physical Examinationmentioning

confidence: 99%

“…22 Advanced cases may even exhibit Gilliatt-Sumner hand, with signs of denervation and atrophy of the abductor pollicis brevis, hypothenar, and interossei muscles (Level V). 23 It is also important to perform neurological testing, such as upper extremity reflexes, assessing for Hoffman's sign and Spurling's test, which if positive, would suggest more proximal disease at the nerve roots or cervical spinal cord. Additionally, rotator cuff exam maneuvers or even point of care ultrasound can help to rule out rotator cuff disease mimicking symptoms of nTOS.…”

Section: Physical Examinationmentioning

confidence: 99%

Neurogenic thoracic outlet syndrome in the overhead and throwing athlete: A narrative review

Troyer

Gardner

Bowers

2022

PM&R

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Thoracic outlet syndrome is an important cause of shoulder pain and dysfunction due to compression of neurovascular structures as they traverse the thoracic outlet. Symptoms are most commonly due to compression of the brachial plexus called neurogenic thoracic outlet syndrome (nTOS). Throwing athletes are at increased risk of nTOS because of a variety of biomechanical factors. However, because nTOS symptoms are often nonspecific, delayed diagnosis is common. Neurogenic thoracic outlet largely remains a diagnosis of exclusion with advanced imaging ruling out vascular involvement and diagnostic injections gaining favor in helping localize sites of compression. Although rehabilitation alone may improve symptoms in some athletes, many require surgical treatment for long-term relief. This generally entails decompression of the thoracic outlet by some combination of muscle release, brachial plexus neurolysis, and first rib resection. Outcomes tend to be successful in athletes with most achieving resolution of symptoms and return to athletic activity. NTOS is an important cause of shoulder pain and dysfunction in throwing athletes. The history and physical examination should focus on activities that exacerbate symptoms. Treatment of nTOS generally requires surgical intervention and allows throwing athletes to return to sport.

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“…We recently proposed that these cases of positional compression without symptoms or complications should not be named TOS but "thoracic outlet compressions" (TOCs) in order to avoid confusion between the two conditions [18]. Ultimately, a small number of patients with TOC or TOS will develop complications or sequelae (CS) as a result of the chronic conflict between the neurovascular bundle and the adjacent structures, such as vascular thrombus or aneurysms [19][20][21], Gilliatt and Sumner hand, and peri-neural fibrosis [22][23][24][25][26]. We also proposed that such cases of "thoracic outlet compression with complications or sequelae" should not be called TOS because the complication may be asymptomatic; instead, they should be referred to as "TOX" (which is a simplified version of TOC-CS) [18].…”

Section: Introductionmentioning

confidence: 99%

Role of Lifestyle in Thoracic Outlet Syndrome: A Narrative Review

Abraham,

Lecoq,

Mechenin

et al. 2024

JCM

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Introduction: The presence of a positional compression of the neurovascular bundle in the outlet between the thorax and the upper limb during arm movements (mainly abduction) is common but remains asymptomatic in most adults. Nevertheless, a certain number of subjects with thoracic outlet positional compression will develop incapacitating symptoms or clinical complications as a result of this condition. Symptomatic forms of positional neurovascular bundle compression are referred to as “thoracic outlet syndrome” (TOS). Materials and methods: This paper aims to review the literature and discuss the interactions between aspects of patients’ lifestyles in TOS. The manuscript will be organized to report (1) the historical importance of lifestyle evolution on TOS; (2) the evaluation of lifestyle in the clinical routine of TOS-suspected patients, with a description of both the methods for lifestyle evaluation in the clinical routine and the role of lifestyle in the occurrence and characteristics of TOS; and (3) the influence of lifestyle on the treatment options of TOS, with a description of both the treatment of TOS through lifestyle changes and the influence of lifestyle on the invasive treatment options of TOS. Results: We report that in patients with TOS, lifestyle (1) is closely related to anatomical changes with human evolution; (2) is poorly evaluated by questionnaires and is one of the factors that may induce symptoms; (3) influences the sex ratio in symptomatic athletes and likely explains why so many people with positional compression remain asymptomatic; and (4) can sometimes be modified to improve symptoms and potentially alter the range of interventional treatment options available. Conclusions: Detailed descriptions of the lifestyles of patients with suspected TOS should be carefully analysed and reported.

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The Gilliatt-Sumner hand: a diagnostic clue of neurogenic thoracic outlet syndrome

Cited by 8 publications

References 5 publications

New Paradigms for Thoracic Outlet Compression and Thoracic Outlet Syndrome, with or without Complications or Sequelae: A Trans-Continental and Trans-Disciplinary Opinion Paper

New Paradigms for Thoracic Outlet Compression and Thoracic Outlet Syndrome, with or without Complications or Sequelae: A Trans-Continental and Trans-Disciplinary Opinion Paper

Neurogenic thoracic outlet syndrome in the overhead and throwing athlete: A narrative review

Role of Lifestyle in Thoracic Outlet Syndrome: A Narrative Review

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