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Understanding thoracic outlet syndrome.

Freischlag J, Orion K - Scientifica (Cairo) (2014)

Bottom Line: Each type is in distinction to the others when considering patient presentation and diagnosis.Remarkable advances have been made in surgical approach, physical therapy, and rehabilitation of these patients.Dedicated centers of excellence with multidisciplinary teams have been developed and continue to lead the way in future research.

View Article: PubMed Central - PubMed

Affiliation: Division of Vascular Surgery, Department of Surgery, The Johns Hopkins Hospital, 720 Rutland Avenue, Ross 759, Baltimore, MD 21205, USA.

ABSTRACT
The diagnosis of thoracic outlet syndrome was once debated in the world of vascular surgery. Today, it is more understood and surprisingly less infrequent than once thought. Thoracic outlet syndrome (TOS) is composed of three types: neurogenic, venous, and arterial. Each type is in distinction to the others when considering patient presentation and diagnosis. Remarkable advances have been made in surgical approach, physical therapy, and rehabilitation of these patients. Dedicated centers of excellence with multidisciplinary teams have been developed and continue to lead the way in future research.

No MeSH data available.


Related in: MedlinePlus

Radiographs show both a fully formed and a partially developed cervical rib (reprinted with permission of Elsevier; see [8]).
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fig2: Radiographs show both a fully formed and a partially developed cervical rib (reprinted with permission of Elsevier; see [8]).

Mentions: Finally, arterial thoracic outlet syndrome (aTOS) is the rarest form accounting for only 1-2%. Continuous friction of the subclavian artery and the underlying first rib from pulsation and activity can cause fibrosis and stenosis of the artery. Poststenotic aneurysms can then form. Both the narrowed artery and aneurysms can cause arterial thrombosis. In the chronic phase, patients experience claudication or pain with activity of the arm/hand which generally subsides with the cessation of movement. In the subacute stage, as emboli form and travel distally, patients present with focal symptoms of ischemia in the form of a severely painful blue or white finger [6]. Acutely, the subclavian artery can completely thrombose, leaving the patient with a threatened limb. Many of these patients will have a cervical rib or other rib anomaly such as a rudimentary rib or fused cervical, 1st and/or second ribs (Figure 2). A recent study from Michigan found an astonishing incidence of 29% for bony abnormalities in their TOS patients and the strongest association occurred with arterial TOS [7].


Understanding thoracic outlet syndrome.

Freischlag J, Orion K - Scientifica (Cairo) (2014)

Radiographs show both a fully formed and a partially developed cervical rib (reprinted with permission of Elsevier; see [8]).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4129179&req=5

fig2: Radiographs show both a fully formed and a partially developed cervical rib (reprinted with permission of Elsevier; see [8]).
Mentions: Finally, arterial thoracic outlet syndrome (aTOS) is the rarest form accounting for only 1-2%. Continuous friction of the subclavian artery and the underlying first rib from pulsation and activity can cause fibrosis and stenosis of the artery. Poststenotic aneurysms can then form. Both the narrowed artery and aneurysms can cause arterial thrombosis. In the chronic phase, patients experience claudication or pain with activity of the arm/hand which generally subsides with the cessation of movement. In the subacute stage, as emboli form and travel distally, patients present with focal symptoms of ischemia in the form of a severely painful blue or white finger [6]. Acutely, the subclavian artery can completely thrombose, leaving the patient with a threatened limb. Many of these patients will have a cervical rib or other rib anomaly such as a rudimentary rib or fused cervical, 1st and/or second ribs (Figure 2). A recent study from Michigan found an astonishing incidence of 29% for bony abnormalities in their TOS patients and the strongest association occurred with arterial TOS [7].

Bottom Line: Each type is in distinction to the others when considering patient presentation and diagnosis.Remarkable advances have been made in surgical approach, physical therapy, and rehabilitation of these patients.Dedicated centers of excellence with multidisciplinary teams have been developed and continue to lead the way in future research.

View Article: PubMed Central - PubMed

Affiliation: Division of Vascular Surgery, Department of Surgery, The Johns Hopkins Hospital, 720 Rutland Avenue, Ross 759, Baltimore, MD 21205, USA.

ABSTRACT
The diagnosis of thoracic outlet syndrome was once debated in the world of vascular surgery. Today, it is more understood and surprisingly less infrequent than once thought. Thoracic outlet syndrome (TOS) is composed of three types: neurogenic, venous, and arterial. Each type is in distinction to the others when considering patient presentation and diagnosis. Remarkable advances have been made in surgical approach, physical therapy, and rehabilitation of these patients. Dedicated centers of excellence with multidisciplinary teams have been developed and continue to lead the way in future research.

No MeSH data available.


Related in: MedlinePlus