Thoracic Outlet Syndrome

The aim of this paper is to present the etiopathogenesis, symptoms and treatment of thoracic outlet syndrome

2008

Scholarcy highlights

  • The aim of this paper is to present the etiopathogenesis, symptoms and treatment of thoracic outlet syndrome
  • Thoracic outlet syndrome is described as pathologic neurological and angiovascular symptoms, appearing in the area of upper limbs, which are caused by pressure directed on the subclavian and axillary artery, as well as on the clavicular vein in the area of the superior aperture of the thorax
  • At testing time some typical TOS symptoms appear such as pain and long-lasting whitening of hand skin as well as its cyanotic hue together with excessive filling of the surface veins; The authors, who described the tests for the first time, considered them to be suitable enough to discover the cause of compression of the vasculo-neural bundle
  • Non-invasive tests: — X-ray of the inner cervical and pectoral area; — segmentary blood pressure measurements by Doppler method at rest and after one of the tests mentioned above, before functional tests; — Duplex-Doppler colour-coded test at rest and in the course of functional tests, both in sitting and lying position; as the vein is most liable to compression, the examinations carried out on patients without venous symptoms with only revealed neurological symptoms allow us to define diagnosis of TOS accurately, if we manage to show compression on the clavicular vein during compression tests ; — reoangiography of the upper limbs; — elecromyography; — neurography — measurement of speed of the elbow nerve conduction in order to estimate the lesion of the brachial plexus; a helpful diagnosis to find the difference between the constriction root syndrome and the constriction of carpal passage
  • The adequate decision on TOS treatment depends on proper diagnosis and precise recognition of various compressed structures: neurological, vascular and mixed
  • Operation treatment should be applied for refractory cases, resistant to physiotherapy and leading to muscular athrophy and strong disorders
  • The chosen procedure, as far as operating treatment is concerned, seems to be resection of the first rib (when

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