Thoracic outlet syndrome: review and reference to stroke in a major league pitcher

Ws, Fields; Lemak, NA; Ben‐Menachem, Yoram

doi:10.2214/ajr.146.4.809

Cited by 57 publications

(53 citation statements)

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“…Although non-operative therapy has been shown to be successful in one case of positional compression of axillary artery [18], many examples of failed nonoperative management resulting in the progression of disease and signifi cant disability from thromboembolic sequelae have been described [19,20]. Thrombolytic therapy may be used initially to dissolve newly formed distal emboli, though recurrences may occur upon return to activity if the underlying embolic source is not addressed.…”

Section: Discussionmentioning

confidence: 99%

Coil embolization of a posterior circumflex humeral aneurysm in a volleyball player

Tao

Eisenberg

Jaskolka

et al. 2016

Vasa

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Key message: Vascular injuries to the posterior circumfl ex humeral artery are a rare clinical entity but may result in digital ischemia due to embolic dislodgement following repetitive and exaggerated overhead motions in active sportspeople. showed satisfactory position of the coils (Fig. 3). Anticoagulation was discontinued after 3 months. Follow-up MRI demonstrated successful occlusion of the right PCHA (Fig. 4). At six months follow-up she was asymptomatic with no complaints and returned to playing volleyball. DiscussionVascular injuries to the posterior circumfl ex humeral artery (PCHA) are a rare but signifi cant problem in highperformance athletes who engage in overhead throwing activities. It has been reported in baseball pitchers [1] and several studies amongst elite volleyball players have documented aneurysm formation of the PCHA [2 -6]. A recent survey revealed that a high percentage of volleyball players in the Netherlands, with a mean age of 24, self-reported symptoms of digital ischemia. The prevalence of cold digits during practice and competition was 27 %. The study was prompted by increased numbers of volleyball players presenting with ischemic digits of the dominant hand associated with vascular injuries to the PCHA and resulting distal emboli [2]. Other literature has demonstrated that a volleyball career longer than 17 years is associated with a 6.7-fold increase in the risk of ischemia-related complaints in the dominant hand [7]. In volleyball, the overhead spiking and serving motion involves excessive external rotation and hyper-abduction of the shoulder [8]. During this manoeuvre, the relatively fi xed circumfl ex arteries are potentially subjected to compression by the humeral head. Cadaver dissections have shown that as the arm is moved into an overhead position, the axillary artery becomes compressed by the humeral head, which acts like a fulcrum [9]. Furthermore, sonographic investigations revealed that the glenohumeral joint is anteriorly translated during the overhead motion and that there is a correlation between such displacement and the degree of axillary artery compression and more distal fl ow-mediated vasodilation [10,11]. Positional compression of the distal axillary artery and its branches may cause chronic irritation leading to aneurysmal degeneration [12]. Turbulent fl ow in these aneurysms readily produces mural thrombus which is susceptible to distal embolisation during hyperextension as the humeral head acts to compress the aneurysm, thus pushing the thrombus into the distal arterial stream [12 -14]. The thromboembolic complications of the aff ected extremity will result in manifestations of digital ischemia, as seen in our patient. Embolic occlusions of the distal arteries in the hand may result in disabling pain, numbness, coldness, discoloration and occasional ulcerations. Clinical presentations of thromboembolic complications, however, can be subtle and often remain undetected for a long time due to the rich collateral network around the shoulder [2]. Importantly, ...

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Section: Discussionmentioning

confidence: 99%

Coil embolization of a posterior circumflex humeral aneurysm in a volleyball player

Tao

Eisenberg

Jaskolka

et al. 2016

Vasa

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“…Da der Verschluss der A. subclavia typi scherweise distal des Abgangs der A. vertebralis lokalisiert ist, gehört das Sub clavian steal Phänomen nicht zur TOS Symptomatik. Sehr selten können retro grade Appositionsthromben den Abgang der A. vertebralis oder der A. carotis miterfassen und zu zerebralen Embolien führen, die Symptome der posterioren Zirkulation oder Hemiplegien verursachen können (Gelabert und Machleder 1997;Fields et al 1986;Matsen et al 2003). Die venöse Form des TOS, auch "thoracic inlet syndrome" genannt, ist mit 2 bis 3 % aller TOS etwa doppelt so häufig wie die arterielle und betrifft typischerwei se gesunde Männer vor dem 50.…”

Section: Das Vaskuläre Thoracic-outlet-syndromunclassified

Thoracic-Outlet-Syndrom (TOS)

Buckup¹,

Buckup²

2012

Klinische Tests an Knochen, Gelenken Und Muskeln

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“…Further investigation of the relationship between such factors and test responses may aid identification of subjects predisposed to arterial compression syndromes and their subsequent management. A predisposition to arterial compression would be especially relevant in the overhead athlete population where repetitive compressive stress and altered haemodynamics may lead to arterial damage and the sequelae described in published case studies (Arko et al, 2001;Fields et al, 1986;Ishitobi et al, 2001;Rohrer et al, 1990;Todd et al, 1998;Vlychou et al, 2001). …”

Section: Article In Pressmentioning

confidence: 99%

“…Compressive injury of the axillary artery most commonly occurs in athletes performing repetitive overhead arm motion (Jackson, 2003 of such injury include baseball pitchers, handball, tennis, and volleyball players (Arko, Harris, Zarins, & Olcott, 2001;Fields, Lemak, & Benmenachem, 1986;Ishitobi et al, 2001;Rohrer, Cardullo, Pappas, Phillips, & Wheeler, 1990;Todd, Benvenisty, Hershon, & Bigliani, 1998;Vlychou, Spanomichos, Chatziioannou, Georganas, & Zavras, 2001). The proposed mechanisms for compressive trauma of the second and third portions of the axillary artery are a tight or hypertrophied pectoralis minor muscle (Dijkstra & Westra, 1978;Finkelstein & Johnston, 1993) and anterior translation of the humeral head (Dijkstra & Westra, 1978;Durham, Yao, Pearce, Nuber, & McCarthy, 1995;Vlychou et al, 2001) combined with repetitive overhead activity.…”

Section: Introductionmentioning

confidence: 99%

“…Clinically, it is postulated that this manoeuvre stresses the vasculature to accurately reproduce the signs (e.g., radial pulse disappearance) and symptoms (e.g., ischaemic pain, paraesthesia, anaesthesia, heaviness) of vascular compromise. Published case studies have used advanced imaging techniques (i.e., arteriograms, angiograms, ultrasound) to confirm suspected vascular compromise of the axillary artery and its branches, with patency of the arteries in a neutral upper limb position compared to a stenosed or occluded vessel in the hyperabducted position (Arko et al, 2001;Cormier, Matalon, & Wolin, 1988;Fields et al, 1986;Ishitobi et al, 2001;Kee et al, 1995;Nijhuis & MullerWiefel, 1991;Redler, Ruland, & McCue, 1986;Reekers, den Hartog, Kuyper, Kromhout, & Peeters, 1993;Rohrer et al, 1990;Schneider, Kasparyan, Altchek, Fantini, & Weiland, 1999;Todd et al, 1998;Vlychou et al, 2001). Imaging results influence the management of the condition which, in many cases, results in surgery.…”

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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Thoracic outlet syndrome: review and reference to stroke in a major league pitcher

Cited by 57 publications

References 1 publication

Coil embolization of a posterior circumflex humeral aneurysm in a volleyball player

Coil embolization of a posterior circumflex humeral aneurysm in a volleyball player

Thoracic-Outlet-Syndrom (TOS)

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

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