Value of Ultrasound in the Diagnosis of Neurogenic Thoracic Outlet Syndrome

Pesser, Niels; Teijink, Joep A.W.; Vervaart, Kimberly; Goeteyn, Jens; Gons, Rob A.R.; Sambeek, Marc R.H.M. van; Nuenen, Bart F.L. van

doi:10.1016/j.ejvs.2020.02.016

Cited by 16 publications

(15 citation statements)

References 5 publications

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“…Usually, patients complain about upper-limb pain, paresthesia and weakness, especially during prolonged elevated arm position or during repetitive upper-limb movements. NTOS remains a challenging diagnosis due to the lack of specificity of the symptoms, the clinical examination and the radiologic exams [ 5 , 7 , 11 , 12 , 13 ]. Thereby, guidelines have recently been proposed for a more consensual diagnosis of NTOS [ 5 , 7 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Hand Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome

Daley

Louguet³

et al. 2021

Diagnostics

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Neurogenic thoracic outlet syndrome (NTOS) is a chronic painful and disabling condition. Patients complain about upper-limb paresthesia or weakness. Weakness has been considered one of the diagnostic criteria of NTOS, but objective comparisons to healthy controls are lacking. We compared the grip and the key pinch strengths between NTOS patients and healthy controls. Grip strength was evaluated with a hydraulic hand dynamometer and the key pinch with a pinch gauge. All the patients with NTOS completed a QuickDASH. We included prospectively 85 patients with NTOS, 73% female and 27% male. The mean age was 40.4 ± 9.6. They were compared to 85 healthy subjects, 77.6% female and 22.4% male. Concerning the grip, symptomatic hands of NTOS patients had significantly 30% less strength compared to control hands (p ≤ 0.001), and 19% less strength compared to asymptomatic hands (p = 0.03). Concerning the key pinch, symptomatic hands of patients with NTOS had significantly 19.5% less strength compared to control hands (p ≤ 0.001). Grip and key pinch strengths had a significant correlation with the QuickDASH (r = −0.515 and r = −0.403, respectively; p ≤ 0.001). Patients with NTOS presented an objective hand strength deficit compared to healthy controls. This deficit was significantly correlated to the upper-limb disability. These findings confirm the interest of hand strength evaluation in the diagnostic process of patients with NTOS.

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Section: Introductionmentioning

confidence: 99%

Hand Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome

Daley

Louguet³

et al. 2021

Diagnostics

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“…NTOS is a challenging diagnosis due to the heterogeneity of the symptoms and the lack of specific laboratory exams [ 1 , 3 , 4 , 16 ]. Recently, guidelines have been proposed to clarify and help make the diagnosis which is based on the absence of other probable diagnosis [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical procedures should be proposed to patients in case of conservative treatment failure [ 6 , 15 ]. Because of the lack of specificity of NTOS, especially concerning complementary exams, clinical guidelines have been recently proposed so as to be more consensual diagnosis [ 4 , 6 , 12 , 16 , 17 , 18 ]. Yet, some studies have assessed the interest of duplex imaging in NTOS [ 19 , 20 ], which may seem relevant given the anatomical proximity between subclavian vessels and brachial plexus.…”

Section: Introductionmentioning

confidence: 99%

Subclavian Vessel Compression Assessed by Duplex Scanning in Patients with Neurogenic Thoracic Outlet Syndrome and No Vascular Signs

Daley

Gautier³

et al. 2021

Diagnostics

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Neurogenic thoracic outlet syndrome (NTOS) is the most frequent form of TOS. It may affect both sides, but specific complementary exams are lacking. We aimed to evaluate duplex scanning results in a group of patients with unilateral or bilateral NTOS and no clinical vascular signs, referred for rehabilitation. We performed a retrospective observational study in patients with unilateral or bilateral NTOS and no vascular symptoms. Subclavian vessels were assessed by duplex scanning. Compressions were considered in case of >50% of increased or decreased blood flow. A total of 101 patients met NTOS criteria; mean age was 40 +/− 10.2; 79.2% women. Seventy patients had a unilateral NTOS and 31 a bilateral form. Duplex scanning showed that 56.4% of the patients had vessels compression, 55.7% in the unilateral group and 58.1% in the bilateral (p = 0.81). In unilateral NTOS, 21 (30%) patients had bilateral vascular compression, 17 (24.3%) had ipsilateral compression and 1 (1.4%) had contralateral compression. In bilateral NTOS, 15 (48.4%) had bilateral compression and 3 (9.7%) compression on only one side. We found a significant difference of the rate of vascular compressions between symptomatic and non-symptomatic upper-limbs, 54.5% vs. 32.9%, respectively, (p = 0.002) and a significant association between symptomatic upper-limbs and vascular compression (OR = 2.45 [95%IC: 1.33–4.49]; p = 0.002). The sensitivity and the specificity of the duplex scanning were 54.5% and 67%, respectively. The ROC curve area was of 0.608 [95%IC: 0.527–0.690]. Despite a highly significant association between symptomatic upper-limbs and vascular compression, duplex scanning did not help make the diagnosis of NTOS.

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“…The EAST can be used before and after the test injection. To objectify the outcome of a scalene muscle test injection, most clinicians use a combination of the EAST and pain questionnaires [4,11]. In our center, we perform an EAST before the test injection and 1 hour after the injection.…”

Section: Role Of the East In Scalene And Minor Pectoral Muscle Test Injectionmentioning

confidence: 99%

“…Unfortunately, modern imaging techniques (e.g. MRI, CT) have not been shown to be conclusive in making the diagnosis, and newer imaging techniques for peripheral nerve disorders such as high-resolution ultrasound show low sensitivity rates in a NTOS population [2][3][4]. As a first step in improving diagnosis and outcomes in NTOS patients, a group of TOS experts endorsed by the Society for Vascular Surgery (US) published, in 2016, a Reporting Standards document attempting to provide consensus on definitions, diagnostic criteria, and outcome measures [5].…”

Section: Introductionmentioning

confidence: 99%

Increasing Objectivity in the Diagnosis of NTOS: The Standardized EAST-Meter

Pesser

Boidin

Sambeek

et al. 2021

Thoracic Outlet Syndrome

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The Elevated Arm Stress Test (EAST) is a provocation test for the upper extremity that plays a key role in the diagnosis of NTOS. In current practice, the EAST is used as part of the physical examination. However, the EAST is subjective in nature due to differences between clinicians in the positioning of the patient, instructions towards the patient, interpretation of symptoms, and reported outcomes. To overcome these limitations a standardized EAST-meter was developed. In this chapter the development of this EASTmeter is described together with some preliminary results in healthy controls and NTOS patients.Critical Take-Home Messages 1. The elevated arm stress test (EAST) is a provocative test that plays a key role in the diagnosis of NTOS. 2. EAST as described is inherently subjective. 3. The EAST-meter is a tool designed to provide objectivity to the standard EAST test. 4. Early experience shows that results derived from the EAST-meter yields accurate time and force measurements.

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Value of Ultrasound in the Diagnosis of Neurogenic Thoracic Outlet Syndrome

Cited by 16 publications

References 5 publications

Hand Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome

Hand Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome

Subclavian Vessel Compression Assessed by Duplex Scanning in Patients with Neurogenic Thoracic Outlet Syndrome and No Vascular Signs

Increasing Objectivity in the Diagnosis of NTOS: The Standardized EAST-Meter

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