Thoracic Outlet Syndrome

Leffert, Robert D.

doi:10.5435/00124635-199411000-00003

Cited by 47 publications

(35 citation statements)

References 30 publications

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“…4,5,11,17,19) Fibromuscular bands or scalene muscle anomalies are also common. In particular, scalene muscle anomalies are the predominant etiological factor in upper plexus TOS.…”

Section: Discussionmentioning

confidence: 99%

“…9,13,17,19) TOS due to compromise of the brachial plexus is known as neurogenic TOS. 2,4,5) Classic TOS presents with lower cervical nerve involvement (C8-T1 nerve roots or lower trunk) with hypesthesia and paresthesia along the distribution of the ulnar nerve. Upper plexus TOS presents with symptoms due to the involvement of the C-5 to C-7 nerve roots, is relatively rare, and can be mistaken for cervical disc disease.…”

Section: Introductionmentioning

confidence: 99%

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Upper Plexus Thoracic Outlet Syndrome. Case Report.

Matsuyama

Okuchi

Goda³

2002

Neurol. Med. Chir.(Tokyo)

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A 47-year-old right-handed female became aware of proximal ache and muscle weakness in the right shoulder and elbow in 1997. Atrophy of the right biceps muscle was recognized and the right deltoid, triceps, supraspinatus, and infraspinatus muscles were weak. The Morley test and elevated arm stress test were positive. Neurolysis of the brachial plexus and anterior scalenectomy were performed via a right supraclavicular approach. An abnormal fibromuscular band was identified passing between the upper and middle trunks and constricting the middle trunk. Another scalene muscle anomaly was found passing between the C-5 and C-6 nerve roots and connecting the anterior and middle scalene muscles. These muscles were resected, and thorough neurolysis was performed around all nerves and the trunks. Postoperatively, all symptoms completely resolved and the patient was discharged 5 days after surgery. Thoracic outlet syndrome (TOS) manifests as symptoms of lower cervical nerve involvements with hypesthesia and paresthesia. However, upper plexus TOS manifests as symptoms due to the involvement of the C-5 to C-7 nerve roots, and is relatively rare. Transaxillary first rib resection is performed as the primary operation for TOS, but supraclavicular scalenectomy is effective for upper plexus TOS.

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“…4,5,11,17,19) Fibromuscular bands or scalene muscle anomalies are also common. In particular, scalene muscle anomalies are the predominant etiological factor in upper plexus TOS.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Upper Plexus Thoracic Outlet Syndrome. Case Report.

Matsuyama

Okuchi

Goda³

2002

Neurol. Med. Chir.(Tokyo)

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“…Controversy over the methods dates back to the early 1900s, when Adson described his test for TOS as being positive when it showed a loss of pulse and the onset of dysesthesia with arm abduction in the elevated posture [6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Background and Purposementioning

confidence: 99%

“…Further electrical studies with nerve conduction and electromyelographic testing, for example, EMG/NCV studies, are not reliable in most areas, with some believing that the diagnosis can be made only by testing the lateral antebrachial cutaneous nerve and the medial antebrachial cutaneous nerve, the sensory branches leading from the brachial plexus to the medial and lateral arm [33,11]; and others believing that conductions across the plexus from Erb's point to the axilla could document the pathology [12,24]. Because of a lack of other objective findings, some neurologists question the diagnosis unless atrophy is present [26].…”

Section: Background and Purposementioning

confidence: 99%

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Dynamic Neuromusculoskeletal Ultrasound Documentation of Brachial Plexus/Thoracic Outlet Compression during Elevated Arm Stress Testing

Fried¹,

Nazarian

2013

Hand (New York, N,Y.)

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Background The diagnosis and validation of thoracic outlet syndrome/brachial plexopathy (TOS) remains a difficult challenge for surgeons, neurologists, and radiologists. This is due to the fact that the responses of standard elevated arm stress tests can be considered somewhat subjective and can vary. Therefore, non-vascular TOS cases are presently diagnosed clinically, and any objective diagnosis has been controversial. Methods This is a technique paper describing the use of dynamic neuromusculoskeletal ultrasound to assist in the diagnosis of thoracic outlet/brachial plexus pathology. We propose a new way to observe the brachial plexus dynamically, so that physical verification of nerve compression between the anterior and middle scalene muscles can be clearly made at the onset of clinical symptoms. This gives a way to objectively identify clinically significant brachial plexus compression. Results Dynamic testing can add objective analysis to tests such as the elevated arm stress tests and can correlate the onset of symptoms with plexus compression between the anterior and middle scalene muscles. With this, the area of pathologic compression can be identified and viewed while performing the dynamic testing. If compression is seen and the onset of symptoms ensues, this is a positive confirmatory test for the presence of TOS and a clinically significant disease. Conclusions This paper offers a simple, objective, and visual diagnostic test that can validate the presence or absence of brachial plexus compression during arm elevation in patients with brachial plexus injury and thoracic outlet syndrome.

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Predictive aspects of the abduction external rotation test among male industrial and office workers

et al. 1999

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Background Nerve compression of the brachial plexus can be provoked by the Abduction External Rotation (AER) test where the arms are held in a “hands‐up” position. Methods The AER test was conducted among 137 male industrial and office workers at baseline and after 5 years follow‐up, together with a medical examination/history and exposure analysis. Nerve conduction measurements in the wrist regions were also made. Results The cumulated incidence of neurological signs during the AER test, was estimated to be 2/100 person‐years. Factors related to work‐conditions, constitution, disease, and neck trauma were associated with AER signs. Subjects with AER signs exhibited a slowing of the nerve conduction velocities in the wrist region. The AER test predicted future neck and upper extremity symptoms and signs of nerve compression. Conclusions The results of this study gave support to the “double or multiple crush” theory of nerve compression. Prevention, evaluation, and management of neck and upper extremity nerve compression diseases should, therefore, attend to all probable locations of such compression, even when a specific location is in focus. The AER test can be a supplementary tool in such work, both in epidemiological and occupational health settings. Am. J. Ind. Med. 35:32–42, 1999. © 1999 Wiley‐Liss, Inc.

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Thoracic Outlet Syndrome

Cited by 47 publications

References 30 publications

Upper Plexus Thoracic Outlet Syndrome. Case Report.

Upper Plexus Thoracic Outlet Syndrome. Case Report.

Dynamic Neuromusculoskeletal Ultrasound Documentation of Brachial Plexus/Thoracic Outlet Compression during Elevated Arm Stress Testing

Predictive aspects of the abduction external rotation test among male industrial and office workers

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