Thoracic Outlet Syndrome

2016 ◽  
Author(s):  
Mark W Fugate ◽  
Julie A Freischlag
Keyword(s):  
Multimodal Treatment ◽  
Thoracic Outlet Syndrome ◽  
Venous Flow ◽  
Treatment Algorithms ◽  
Effort Thrombosis ◽  
First Rib Resection ◽  
Neurovascular Structures ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs ◽  
Neurogenic Tos

Thoracic outlet syndrome (TOS) is a condition caused by compression of the neurovascular structures leading to the arm passing through the thoracic outlet. The incidence of TOS is reported as 0.3 to 2% in the general population. There are three distinct types of TOS: neurogenic (95%), venous (4%), and arterial (1%). Treatment algorithms depend on the type of TOS. Arterial and venous TOS often present urgently with arterial or venous thrombosis, which is fairly easily identified by thorough history taking and a physical examination. Diagnosis is also aided by duplex ultrasonography. Restoration of arterial or venous flow can often be readily accomplished by thrombolysis. More important, however, is the diagnosis of the underlying structural component involved in the development of symptoms. Although statistically the most common, neurogenic TOS is often the most difficult to diagnose and treat. There are good data indicating that appropriately selected patients benefit from surgical therapy for neurogenic TOS as well. To prevent recurrence of symptoms, patients must undergo first rib resection and anterior scalenectomy, as well as resection of any rudimentary or cervical ribs. Regardless of the type of TOS encountered, proper therapy requires a thorough diagnostic evaluation and multimodal treatment. Keywords: thoracic outlet syndrome, arterial thoracic outlet syndrome, neurogenic thoracic outlet syndrome, venous thoracic outlet syndrome, TOS, effort thrombosis, thoracic outlet decompression

scholarly journals Arterial Thoracic Outlet Syndrome Treated Successfully with Totally Endoscopic First Rib Resection

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Sofoklis Mitsos ◽  
Davide Patrini ◽  
Sara Velo ◽  
Achilleas Antonopoulos ◽  
Martin Hayward ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Thoracoscopic Surgery ◽  
Signs And Symptoms ◽  
Rib Resection ◽  
First Rib ◽  
Endoscopic Video ◽  
First Rib Resection ◽  
Neurovascular Structures ◽  
Arterial Thoracic Outlet Syndrome ◽  
Video Assisted Thoracoscopic Surgery

Thoracic outlet syndrome (TOS) is a constellation of signs and symptoms caused by compression of the neurovascular structures in the thoracic outlet. TOS may be classified as either neurogenic TOS (NTOS) or vascular TOS: venous TOS (VTOS) or arterial TOS (ATOS), depending on the specific structure being affected. The basis for the surgical treatment of TOS is resection of the first rib, and it may be combined with scalenectomy or cervical rib resection. Herein, we describe a case of arterial thoracic outlet syndrome which was successfully treated with totally endoscopic video-assisted thoracoscopic surgery (VATS) first rib resection.

Undiagnosed bilateral complete cervical rib with subclavian artery aneurysm presenting as acute ischaemic limb following high-altitude expedition

2021 ◽  
Vol 14 (2) ◽  
pp. e241194
Author(s):  
Raja Lahiri ◽  
Udit Chauhan ◽  
Ajay Kumar ◽  
Nisanth Puliyath
Keyword(s):  
High Altitude ◽  
Subclavian Artery ◽  
Thoracic Outlet Syndrome ◽  
Artery Aneurysm ◽  
Limb Ischaemia ◽  
Cervical Rib ◽  
Subclavian Artery Aneurysm ◽  
Acute Limb Ischaemia ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs

Arterial thoracic outlet syndrome is relatively rare and often exclusively seen in the presence of bony anomalies. High-altitude (HA) travel is commonly associated with thrombosis; however, arterial thromboembolism is less frequently described. We describe a case of a young man with undiagnosed bilateral cervical rib, who went for an HA trek, subsequent to which developed acute limb ischaemia of right arm. Diagnostic workup revealed a subclavian artery aneurysm as well along with complete bony bilateral cervical ribs. Thoracic outlet syndrome should be kept as a differential diagnosis in a case of acute limb ischaemia in a healthy adult.

Arterial Thoracic Outlet Syndrome

2018 ◽  
Author(s):  
Besem Beteck ◽  
John Eidt ◽  
Bradley Grimsley
Keyword(s):  
Subclavian Artery ◽  
Thoracic Outlet Syndrome ◽  
Computed Tomographic Angiography ◽  
Rib Resection ◽  
Computed Tomographic ◽  
First Rib ◽  
Arterial Complication ◽  
Scalene Triangle ◽  
First Rib Resection ◽  
Arterial Thoracic Outlet Syndrome

Arterial thoracic outlet syndrome (TOS) is the least common form of TOS in adults. It is an entity that is associated with bony anomalies resulting in chronic subclavian artery compression. Most patients with arterial TOS are young adults presenting either with limb-threatening upper extremity ischemia or chronic symptoms suggestive of arterial insufficiency involving the extremity. Initial diagnostic evaluation involves chest radiography, which may reveal cervical or anomalous first rib. Catheter-based arteriography has a diagnostic as well as therapeutic role. Magnetic resonance angiography and computed tomographic angiography, which are readily available, can be used in surgical planning. Treatment involves revascularization of the extremity, subsequent first rib resection, and possible reconstruction of the subclavian artery. This review contains 4 figures, 1 table and 45 references Key Words: arterial complication, brachial thromboembolectomy, cervical rib, costoclavicular space, first rib resection, pectoralis minor space, scalene triangle, subclavian artery stenosis, thoracic outlet syndrome

Diagnosis and Treatment of Arterial Thoracic Outlet Syndrome in a Collegiate Volleyball Player: A Case Report

2020 ◽  
Vol 25 (6) ◽  
pp. 307-313
Author(s):  
Katherine Craig ◽  
Shannon L. Jordan ◽  
Daniel R. Chilek ◽  
Doug Boatwright ◽  
Julio Morales
Keyword(s):  
Case Report ◽  
Range Of Motion ◽  
Sports Medicine ◽  
Thoracic Outlet Syndrome ◽  
Return To Play ◽  
Provocation Tests ◽  
Volleyball Player ◽  
First Rib ◽  
First Rib Resection ◽  
Arterial Thoracic Outlet Syndrome

A 19-year-old female volleyball player reported shoulder pain, numbness, tingling, and difficulty gripping in her left arm. Provocation tests were positive for thoracic outlet syndrome (TOS). Duplex ultrasonography revealed occlusion of the subclavian artery. The athlete underwent a first rib resection and scalenectomy. A cervical rib and 75% of the first rib were excised. Rehabilitation consisted of regaining range of motion and strength. Return to play occurred after 14 weeks of rehabilitation. Thoracic outlet syndrome is rare and often misdiagnosed. All sports medicine professionals should have an understanding of TOS symptoms and path to diagnosis.

scholarly journals Ar įmanoma diagnozuoti viršutinės krūtinės ląstos atvaros sindromą?

2008 ◽  
Vol 6 (2) ◽  
pp. 0-0
Author(s):  
Ilona Bičkuvienė ◽  
Auksė Meškauskienė
Keyword(s):  
Diagnostic Tests ◽  
Thoracic Outlet Syndrome ◽  
Correct Diagnosis ◽  
Clinical Problem ◽  
Rib Resection ◽  
Patient Groups ◽  
Vertebrobasilar Stroke ◽  
Vilnius University ◽  
First Rib Resection ◽  
Neurogenic Tos

Ilona Bičkuvienė, Auksė MeškauskienėVilniaus universiteto Neurologijos ir neurochirurgijos klinika, Vilniaus greitosios pagalbosuniversitetinės ligoninės Neuroangiochirurgijos centras, Šiltnamių g. 29, LT-04130 Vilnius Viršutinės krtūtinės ląstoa atvaros sindromas (angl. thoracic outlet syndrome, TOS) – viena iš labiausiai ginčytinų klinikinių problemų medicinoje. Nėra patikimų diagnostinių testų, menki pagalbininkai įvairūs tyrimai nustatant TOS diagnozę. Yra gydytojų, neigiančių šio sindromo egzistavimą. Straipsnyje aptariamos sindromo diagnozavimo galimybės ir gydymo būdai. Tirtos dvi ligonių grupės – 16 pacientų, kuriems buvo neurogeninis TOS, ir 54 ligoniai, kuriems, be TOS klinikos, dar pasireiškė praeinančio vertebrobazilinio baseino kraujotakos sutrikimo priepuoliai ir išeminis insultas. Visi ligoniai operuoti. Atlikta skalenektomija, pirmo ir kaklo šonkaulių rezekcija. Pirmos grupės daugumai ligonių simptomai išnyko arba labai sumažėjo, antros grupės nė vienas ligonis nesijautė visiškai sveikas, dviem diagnozuotas pooperacinis išeminis insultas vertebrobaziliniame baseine. Praėjus dvejiems metams po pirmojo šonkaulio rezekcijos, o po skalenektomijos – vos keliems mėnesiams, simptomai atsinaujino (atitinkamai 16% ir 17%). Taigi, būtina kruopšti anamnezė ir nuoseklus klinikinis ligonio ištyrimas, kad būtų galima diagnozuoti TOS. Pagrindiniai žodžiai: TOS, klinikinis ligonio tyrimas, gydymas Diagnostics of thoracic outlet syndrome: Is it possible? Ilona Bičkuvienė, Auksė MeškauskienėVilnius University, Clinic of Neurology and Neurosurgery,Vilnius University Emergency Hospital, Šiltnamių 29, LT-04130 Vilnius, Lithuania TOS is the most controversial clinical problem in medicine. The diagnosis of TOS has always been difficult. There are no infallible diagnostic tests and methods. Some physicians deny its existence. The diagnostic and treatement possibilities are discussed. Two patient groups were evaluated – 16 patients with neurogenic TOS and 54 cases of TOS with vertebrobasilar transitorial ischaemic attacks and strokes. All patients were operated on. Scalenectomy, first and cervical rib resection were performed. In the majority of cases, after surgical treatment symptoms disappeared or significantly decreased in the first patient group. No one was healthy in the second group, and postoperative vertebrobasilar stroke was diagnosed for two patients. The recurrent TOS was diagnosed after two years after the first rib resection and only several months after scalenectomy (16% and 17% respectively). TOS needs to be diagnosed and treated, even if the correct diagnosis still depends on a careful clinical evaluation and physical examination of each patient. Key words: TOS, clinical examination, treatment

scholarly journals A Never Described Variant of the Cervical Rib Causing Arterial Thoracic Outlet Syndrome: World's First Case

2021 ◽  
Vol 07 (03) ◽  
pp. e179-e183
Author(s):  
Saif Abdeali A. Kaderi ◽  
Pravin Shinde ◽  
Raviraj Tilloo ◽  
Sonewane Chetan ◽  
Tanvi Dalal ◽  
...  
Keyword(s):  
Oral Anticoagulation ◽  
Thoracic Outlet Syndrome ◽  
Transverse Process ◽  
Rest Pain ◽  
Postoperative Course ◽  
Cervical Rib ◽  
Artery Thrombosis ◽  
First Case ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs

AbstractCervical ribs, also known as Eve's ribs, are rare and found in 1% of population. They are more common in females and more common on right side. They are asymptomatic in 90% of cases. Cervical rib fused with transverse process of sixth vertebra is rarer. We present a case of dry gangrene of lateral three fingers with right radial and subclavian artery thrombosis with rest pain, due to right cervical rib fused with transverse process of sixth vertebra. After development of line of demarcation of the dry gangrene, patient was operated for excision of cervical rib and sixth cervical vertebral transverse process followed by Ray's amputation of right second finger. Postoperative course was uneventful. Patient was discharged with oral anticoagulation and a healthy wound in right hand.

scholarly journals Vascular pectoralis minor syndrome as an overlooked condition: A case report

2021 ◽  
Vol 67 (4) ◽  
pp. 538-541
Author(s):  
İlknur Aktaş ◽  
Ezgi Kaya ◽  
Pınar Akpınar ◽  
Feyza Ünlü Özkan ◽  
Ahmet Vural ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Female Patient ◽  
Muscle Weakness ◽  
Thoracic Outlet Syndrome ◽  
Ultrasound Guided ◽  
Treatment Methods ◽  
Pectoralis Minor ◽  
Neurovascular Structures ◽  
Cervical Ribs

Thoracic outlet syndrome is characterized by pain, paresthesia, muscle weakness, and arterial/venous symptoms caused by compression of the neurovascular structures. Compression mainly occurs at three distinct areas in the thoracic outlet: the retropectoralis minor space, the costoclavicular space, and the interscalene triangle. As the symptoms of these three compression sites are very similar, it is difficult to pinpoint the location of the compression and the treatment methods are quite different. Ultrasound-guided diagnostic injections play an important role in the differential diagnosis. Herein, we report a 49-year-old female patient who was previously diagnosed with thoracic outlet syndrome and scheduled for decompression of cervical ribs, but cured by conservative methods after being diagnosed with pectoralis minor syndrome.

scholarly journals Percutaneous Thrombectomy in the Management of Early Rethrombosis in Venous Thoracic Outlet Syndrome: Two Case Reports

2021 ◽  
Author(s):  
Ján Sýkora ◽  
Kamil Zeleňák ◽  
Martin Vorčák ◽  
Adam Krkoška ◽  
Štefánia Vetešková ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Treatment Algorithm ◽  
Limited Data ◽  
Case Presentation ◽  
Percutaneous Mechanical Thrombectomy ◽  
Catheter Directed Thrombolysis ◽  
Effort Thrombosis ◽  
First Rib Resection

Abstract BackgroundVenous thoracic outlet syndrome resulting in the upper limb deep venous thrombosis is known as Paget–Schroetter syndrome or effort thrombosis. A general treatment algorithm includes catheter-directed thrombolysis followed by surgical thoracic outlet decompression. There are limited data regarding endovascular treatment of rethrombosis presenting early after the surgery.Case presentationTwo cases of early rethrombosis successfully treated with percutaneous mechanical thrombectomy by two different techniques are described. In both cases, rethrombosis was diagnosed soon after thrombolysis and first rib resection with scalenectomy. After 6 months, both patients remain symptom-free, with patent subclavian veins confirmed by duplex ultrasonography. ConclusionPercutaneous mechanical thrombectomy devices may offer a safe treatment option for patients with recurrent thrombosis after thoracic outlet surgery, even when thrombolytic therapy is contraindicated.

Thoracic Outlet Syndrome

Neurosurgery ◽  
2004 ◽  
Vol 55 (4) ◽  
pp. 897-903 ◽  
Author(s):  
Jason H. Huang ◽  
Eric L. Zager
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Treatment Options ◽  
Surgical Anatomy ◽  
Diagnostic Tools ◽  
Surgical Approaches ◽  
Neurovascular Compression ◽  
Transaxillary Approach ◽  
Detailed Medical History ◽  
First Rib Resection ◽  
Neurogenic Tos

Abstract OBJECTIVE: Thoracic outlet syndrome (TOS) is one of the most controversial clinical entities in medicine. We provide a review of this difficult-to-treat disorder, including a brief overview, clinical presentations, surgical anatomy, treatment options, and outcomes. METHODS: TOS represents a spectrum of disorders encompassing three related syndromes: compression of the brachial plexus (neurogenic TOS), compression of the subclavian artery or vein (vascular TOS), and the nonspecific or disputed type of TOS. Neurovascular compression may be observed most commonly in the interscalene triangle, but it also has been described in the costoclavicular space and in the subcoracoid space. Patients present with symptoms and signs of arterial insufficiency, venous obstruction, painless wasting of intrinsic hand muscles, paresthesia, and pain. A careful and detailed medical history and physical examination are the most important diagnostic tools for proper identification of TOS. Electromyography, nerve conduction studies, and imaging of the cervical spine and the chest also can provide helpful information regarding diagnosis. Clinical management usually starts with conservative treatment including exercise programs and physical therapy; when these therapies fail, patients are considered for surgery. Two of the most commonly used surgical approaches are the supraclavicular exposure and the transaxillary approach with first rib resection. On occasion, these approaches may be combined or, alternatively, posterior subscapular exposure may be used in selected patients. CONCLUSION: TOS is perhaps the most difficult entrapment neuropathy encountered by neurosurgeons. Surgical intervention is indicated for vascular and true neurogenic TOS and for some patients with the common or nonspecific type of TOS in whom nonoperative therapies fail. With careful patient selection, operative intervention usually yields satisfactory results.

Sign in / Sign up

Export Citation Format

Share Document