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

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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Neurogenic Thoracic Outlet Syndrome Caused by Vascular Compression of the Brachial Plexus: A Report of Two Cases

Journal of Brachial Plexus and Peripheral Nerve Injury ◽

10.1055/s-0037-1607977 ◽

2018 ◽

Vol 13 (01) ◽

pp. e1-e3

Author(s):

Amgad Hanna ◽

Larry Bodden ◽

Gabriel Siebiger

Keyword(s):

Brachial Plexus ◽

Thoracic Outlet Syndrome ◽

Vascular Compression ◽

Repetitive Motion ◽

Physical Trauma ◽

Neurogenic Thoracic Outlet Syndrome ◽

Inferior Portion ◽

Pass Through ◽

Neurogenic Tos

AbstractThoracic outlet syndrome (TOS) is caused by compression of the brachial plexus and/or subclavian vessels as they pass through the cervicothoracobrachial region, exiting the chest. There are three main types of TOS: neurogenic TOS, arterial TOS, and venous TOS. Neurogenic TOS accounts for approximately 95% of all cases, and it is usually caused by physical trauma (posttraumatic etiology), chronic repetitive motion (functional etiology), or bone or muscle anomalies (congenital etiology). We present two cases in which neurogenic TOS was elicited by vascular compression of the inferior portion of the brachial plexus.

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Preoperative Duplex Scanning is a Helpful Diagnostic Tool in Neurogenic Thoracic Outlet Syndrome

Vascular and Endovascular Surgery ◽

10.1177/1538574415623650 ◽

2016 ◽

Vol 50 (1) ◽

pp. 29-32 ◽

Cited By ~ 8

Author(s):

Megan S. Orlando ◽

Kendall C. Likes ◽

Serene Mirza ◽

Yue Cao ◽

Anne Cohen ◽

...

Keyword(s):

Diagnostic Tool ◽

Thoracic Outlet Syndrome ◽

Duplex Scanning ◽

Neurogenic Thoracic Outlet Syndrome

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Our Surgical Strategy for Thoracic Outlet Syndrome

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.62 ◽

2018 ◽

Vol 1 (2) ◽

Author(s):

Yasuhiro Nakajima

Keyword(s):

Brachial Plexus ◽

Thoracic Outlet Syndrome ◽

Vascular Compression ◽

Compression Tests ◽

Provocation Tests ◽

Diagnosis Method ◽

Tunnel Syndrome ◽

Electrophysiological Examination ◽

Sensory Neural ◽

Plexus Block

Surgical treatment for thoracic outlet syndrome (TOS) is a very controversial surgery because objective diagnosis, such as image and electrophysiological examination, is very difficult. Clinical provocation tests including brachial plexus compression tests, such as Morley and Roos, and vascular compression tests, such as Wright and Eden ,are not high in specificity and are likely to be positive even in healthy persons and patients with carpal tunnel syndrome. We place emphasis on the laterality of latency and amplitude in the sensory neural action potential (SNAP) of the medial antebrachial cutaneous nerve and ulnar nerve. After enough stretching exercises of scapular stabilizers and brachial plexus block, we always select surgery. In this presentation, I would like to show our diagnosis method and treatment strategy including surgery.

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Evaluation of the Muscular FORCE in the Upper Limbs of Patients Presenting a Thoracic Outlet Syndrome

Case Medical Research ◽

10.31525/ct1-nct04145778 ◽

2019 ◽

Author(s):

Keyword(s):

Thoracic Outlet Syndrome ◽

Upper Limbs ◽

Muscular Force

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Anesthetic Techniques for Fetal Surgery

Anesthesiology ◽

10.1097/aln.0b013e318283c954 ◽

2013 ◽

Vol 118 (4) ◽

pp. 796-808 ◽

Cited By ~ 16

Author(s):

Pornswan Ngamprasertwong ◽

Erik C. Michelfelder ◽

Shahriar Arbabi ◽

Yun Suk Choi ◽

Christopher Statile ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Function ◽

Fetal Surgery ◽

Left Ventricular ◽

High Dose ◽

Anesthetic Techniques ◽

Uterine Blood Flow ◽

Fetal Cardiac Function ◽

Significant Difference ◽

Fetal Acidosis

Abstract Background: Use of high-dose inhalational anesthesia during open fetal surgery may induce maternal–fetal hemodynamic instability and fetal myocardial depression. The authors’ preliminary human retrospective study demonstrated less fetal bradycardia and left ventricular systolic dysfunction with lower dose desflurane supplemented with propofol and remifentanil IV anesthesia (SIVA). In this animal study, the authors compare maternal–fetal effects of high-dose desflurane anesthesia (HD-DES) and SIVA. Methods: Of 26 instrumented midgestational ewes, data from 11 animals exposed to both SIVA and HD-DES in random sequences and six animals exposed to HD-DES while maternal normotension was maintained were analyzed. Maternal electroencephalography was used to guide comparable depths of anesthesia in both techniques. Hemodynamic parameters, blood gas, and fetal cardiac function from echocardiography were recorded. Results: Compared with SIVA, HD-DES resulted in significant maternal hypotension (mean arterial pressure difference, 19.53 mmHg; 95% CI, 17.6–21.4; P < 0.0001), fetal acidosis (pH 7.11 vs. 7.24 at 150 min, P < 0.001), and decreased uterine blood flow. In the HD-DES group with maternal normotension, uterine blood flow still declined and fetal acidosis persisted, with no statistically significant difference from the group exposed to HD-DES that had maternal hypotension. There was no statistically significant difference in fetal cardiac function. Conclusion: In sheep, SIVA affects maternal hemodynamics less and provides better fetal acid/base status than high-dose desflurane. Fetal echocardiography did not reflect myocardial dysfunction in this model.

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Anatomic Variation of the Phrenic Nerve and Brachial Plexus Encountered during 100 Supraclavicular Decompressions for Neurogenic Thoracic Outlet Syndrome with Associated Postoperative Neurologic Complications

Annals of Vascular Surgery ◽

10.1016/j.avsg.2019.04.010 ◽

2020 ◽

Vol 62 ◽

pp. 70-75 ◽

Cited By ~ 1

Author(s):

Scott R. Golarz ◽

Joseph M. White

Keyword(s):

Brachial Plexus ◽

Phrenic Nerve ◽

Thoracic Outlet Syndrome ◽

Anatomic Variation ◽

Neurologic Complications ◽

Neurogenic Thoracic Outlet Syndrome

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Arterial Digital Pulse Photoplethysmography in Patients with Suspected Thoracic Outlet Syndrome: A Study of the “Ca+Pra” Maneuver

Diagnostics ◽

10.3390/diagnostics11061128 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1128

Author(s):

Jeanne Hersant ◽

Pierre Ramondou ◽

Francine Thouveny ◽

Mickael Daligault ◽

Mathieu Feuilloy ◽

...

Keyword(s):

Thoracic Outlet Syndrome ◽

Pulse Amplitude ◽

Receiver Operating Characteristics ◽

Upper Limbs ◽

Operating Characteristics ◽

Digital Pulse ◽

Arterial Inflow ◽

Receiver Operating

The level of pulse amplitude (PA) change in arterial digital pulse plethysmography (A-PPG) that should be used to diagnose thoracic outlet syndrome (TOS) is debated. We hypothesized that a modification of the Roos test (by moving the arms forward, mimicking a prayer position (“Pra”)) releasing an eventual compression that occurs in the surrender/candlestick position (“Ca”) would facilitate interpretation of A-PPG results. In 52 subjects, we determined the optimal PA change from rest to predict compression at imaging (ultrasonography +/− angiography) with receiver operating characteristics (ROC). “Pra”-PA was set as 100%, and PA was expressed in normalized amplitude (NA) units. Imaging found arterial compression in 23 upper limbs. The area under ROC was 0.765 ± 0.065 (p < 0.0001), resulting in a 91.4% sensitivity and a 60.9% specificity for an increase of fewer than 3 NA from rest during “Ca”, while results were 17.4% and 98.8%, respectively, for the 75% PA decrease previously proposed in the literature. A-PPG during a “Ca+Pra” test provides demonstrable proof of inflow impairment and increases the sensitivity of A-PPG for the detection of arterial compression as determined by imaging. The absence of an increase in PA during the “Ca” phase of the “Ca+Pra” maneuver should be considered indicative of arterial inflow impairment.

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The role of ultrasound imaging in vascular compression syndromes

The Ultrasound Journal ◽

10.1186/s13089-020-00202-6 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Renato Farina ◽

Pietro Valerio Foti ◽

Andrea Conti ◽

Francesco Aldo Iannace ◽

Isabella Pennisi ◽

...

Keyword(s):

Thoracic Outlet Syndrome ◽

Clinical Signs ◽

Vascular Compression ◽

Nutcracker Syndrome ◽

Vascular Changes ◽

False Negatives ◽

Dunbar Syndrome ◽

Level Method ◽

Compression Syndromes

AbstractVascular compression syndromes are rare alterations that have in common the compression of an arterial and/or venous vessel by contiguous structures and can be congenital or acquired. The best known are the Thoracic Outlet Syndrome, Nutcracker Syndrome, May–Thurner Syndrome, and Dunbar Syndrome. The incidence of these pathologies is certainly underestimated due to the non-specific clinical signs and their frequent asymptomaticity. Being a first-level method, Ultrasound plays a very important role in identifying these alterations, almost always allowing a complete diagnostic classification. If in expert hands, this method can significantly contribute to the reduction of false negatives, especially in the asymptomatic population, where the finding of the aforementioned pathologies often happens randomly following routine checks. In this review, we briefly discuss the best known vascular changes, the corresponding ultrasound anatomy, and typical ultrasound patterns.

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