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Woodworth TT, Le A, Miller C, Conger A, Mahan MA, Cushman DM. Botulinum toxin injections for the treatment of neurogenic thoracic outlet syndrome: A systematic review. Muscle Nerve 2024; 70:28-35. [PMID: 38529885 DOI: 10.1002/mus.28080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
Botulinum toxin (BTX) injections into the musculature surrounding the brachial plexus have been examined as a potential treatment for neurogenic thoracic outlet syndrome (nTOS). This systematic review identified 15 publications, of which one was a randomized controlled trial. BTX injections performed with ultrasound or electromyographic guidance, and with the inclusion of the pectoralis minor muscle, in addition to the anterior and/or middle scalenes, tended to provide greater symptom improvement and may predict response to first rib resection. Importantly, most studies were of low quality; thus, the results should be interpreted with caution. Further high-quality studies are needed to confirm these findings.
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Affiliation(s)
- Tyler T Woodworth
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Austin Le
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Campbell Miller
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Aaron Conger
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Mark A Mahan
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel M Cushman
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
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2
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Zahn C, Puga C, Malik A, Khanna D. Painful Raynaud's mimics. Best Pract Res Clin Rheumatol 2024:101948. [PMID: 38704280 DOI: 10.1016/j.berh.2024.101948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
Raynaud's syndrome is a common finding in many autoimmune conditions. Accurately diagnosing Raynaud's, and differentiating it from mimicking conditions, is imperative in rheumatologic diseases. Raynaud's syndrome and Raynaud's mimickers, especially painful Raynaud's mimickers, can prove a diagnostic challenge for the practicing rheumatologist. Painful Raynaud's mimickers can lead to increased patient stress and unnecessary medical work up; Healthcare providers need to be aware of Raynaud's mimickers when evaluating patient concerns of skin color changes and pain. The present narrative review aims to highlight Raynaud's syndrome, important painful mimickers that may be seen, diagnosis, and updated management recommendations.
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Affiliation(s)
- Carleigh Zahn
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, 300 North Ingalls Building - Rm 7C27, Ann Arbor, MI, 48109, USA.
| | - Cindy Puga
- Cedars Sinai Internal Medicine Residency, 8700 Beverly Blvd, Becker Bldg. B105 A, Los Angeles, CA, 90048, USA.
| | - Aroosa Malik
- Department of Internal Medicine, Division of Vascular Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, 300 North Ingalls Building - Rm 7C27, Ann Arbor, MI, 48109, USA.
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3
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Lam TQ, Nguyen ADQ, Tran TM, Van Hoang D, Quach TH. A rare case of overlapping thoracic outlet syndrome attributed to an anatomical variation in the anterior scalene muscle: Diagnostic challenges and treatment approaches. Radiol Case Rep 2024; 19:1596-1607. [PMID: 38333903 PMCID: PMC10850128 DOI: 10.1016/j.radcr.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Mixed thoracic outlet syndrome, which compresses arteries and nerves, is a rare disorder. Mixed thoracic outlet syndrome due to anatomical abnormalities of the anterior scalene muscle is even more sporadic. We report a case of mixed thoracic outlet syndrome in a patient with no history of trauma or vigorous exercise. We reviewed the medical literature, emphasizing the clinical role and the role of diagnostic imaging methods in a sequential approach to this syndrome.
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Khoury MK, Thornton MA, Dua A. Systematic review of intermediate and long-term results of thoracic outlet decompression. Semin Vasc Surg 2024; 37:90-97. [PMID: 38704189 DOI: 10.1053/j.semvascsurg.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/06/2023] [Accepted: 01/19/2024] [Indexed: 05/06/2024]
Abstract
Thoracic outlet syndrome (TOS) consists of a group of disorders resulting from compression of the neurovascular bundle exiting through the thoracic outlet. TOS can be classified as follows based on the etiology of the pathophysiology: neurogenic TOS, venous TOS, arterial TOS, and mixed TOS. The constellation of symptoms a patient may experience varies, depending on the structures involved. Due to the wide range of etiologies and presenting symptoms, treatments for TOS also differ. Furthermore, most studies focus on the perioperative and short-term outcomes after surgical decompression for TOS. This systematic review aimed to provide a pooled analysis of studies to better understand the intermediate and long-term outcomes of surgical decompression for TOS. We conducted a systematic literature search in the Ovid MEDLINE, Embase, and Google Scholar databases for studies that analyzed long-term outcomes after surgical decompression for TOS. The inclusion period was from January 2015 to May 2023. The primary outcome was postoperative QuickDASH Outcome Measure scores. A total of 16 studies were included in the final analysis. The differences between postoperative and preoperative QuickDASH Outcome Measure scores were calculated, when possible, and there was a mean overall difference of 33.5 points (95% CI, 25.2-41.8; P = .001) after surgical decompression. There was a higher proportion of excellent outcomes reported for patients undergoing intervention for arterial and mixed TOS etiologies, whereas those with venous and neurogenic etiologies had the lowest proportion of excellent outcomes reported. Patients with neurogenic TOS had the highest proportion of poor outcomes reported. In conclusion, surgical decompression for TOS has favorable long-term outcomes, especially in patients with arterial and mixed etiologies.
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Affiliation(s)
- Mitri K Khoury
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Boston, MA, 02114
| | - Micah A Thornton
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Boston, MA, 02114
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Boston, MA, 02114.
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Abraham P, Lecoq S, Mechenin M, Deveze E, Hersant J, Henni S. Role of Lifestyle in Thoracic Outlet Syndrome: A Narrative Review. J Clin Med 2024; 13:417. [PMID: 38256551 PMCID: PMC10816325 DOI: 10.3390/jcm13020417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The presence of a positional compression of the neurovascular bundle in the outlet between the thorax and the upper limb during arm movements (mainly abduction) is common but remains asymptomatic in most adults. Nevertheless, a certain number of subjects with thoracic outlet positional compression will develop incapacitating symptoms or clinical complications as a result of this condition. Symptomatic forms of positional neurovascular bundle compression are referred to as "thoracic outlet syndrome" (TOS). MATERIALS AND METHODS This paper aims to review the literature and discuss the interactions between aspects of patients' lifestyles in TOS. The manuscript will be organized to report (1) the historical importance of lifestyle evolution on TOS; (2) the evaluation of lifestyle in the clinical routine of TOS-suspected patients, with a description of both the methods for lifestyle evaluation in the clinical routine and the role of lifestyle in the occurrence and characteristics of TOS; and (3) the influence of lifestyle on the treatment options of TOS, with a description of both the treatment of TOS through lifestyle changes and the influence of lifestyle on the invasive treatment options of TOS. RESULTS We report that in patients with TOS, lifestyle (1) is closely related to anatomical changes with human evolution; (2) is poorly evaluated by questionnaires and is one of the factors that may induce symptoms; (3) influences the sex ratio in symptomatic athletes and likely explains why so many people with positional compression remain asymptomatic; and (4) can sometimes be modified to improve symptoms and potentially alter the range of interventional treatment options available. CONCLUSIONS Detailed descriptions of the lifestyles of patients with suspected TOS should be carefully analysed and reported.
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Affiliation(s)
- Pierre Abraham
- Service of Sports Medicine, University Hospital, 49100 Angers, France;
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
- INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, University Angers, 49100 Angers, France
| | - Simon Lecoq
- Service of Sports Medicine, University Hospital, 49100 Angers, France;
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
| | - Muriel Mechenin
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
| | - Eva Deveze
- Service of Thoracic and Vascular Surgery, University Hospital, 49100 Angers, France
| | - Jeanne Hersant
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
| | - Samir Henni
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
- INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, University Angers, 49100 Angers, France
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Martínez-Cárdenas EK, Torres-Parlange A, Sotelo-Carbajal J, Hernández-Zamora RE, García-Ledezma A, Torres-Salazar QL. Case report on the diagnosis of vascular thoracic outlet syndrome followed by mechanical thrombectomy. Int J Surg Case Rep 2023; 113:109019. [PMID: 37988987 PMCID: PMC10667732 DOI: 10.1016/j.ijscr.2023.109019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The thoracic outlet syndrome is characterized by compression of the brachial plexus or subclavian vessels due to anatomical alterations of the thoracic cavity. Vascular presentation is rare and includes thromboembolism and edema in the upper limb, and the diagnosis is often elusive due to its rarity. In this case, we describe a vascular thoracic outlet syndrome presentation whose diagnosis through angiography was achieved after a mechanical thrombectomy. CASE PRESENTATION We report a 43-year-old female patient with pain in the right upper limb, accompanied by edema and mild violet discoloration, without risk factors for hypercoagulability, with D-dimer levels within normal values. Mechanical thrombectomy with AngioJET was performed via an endovascular approach, with the extraction of multiple clots, confirming the presence of thoracic outlet syndrome as the underlying cause of the current condition. CLINICAL DISCUSSION AND CONCLUSIONS Venous thoracic outlet syndrome is a challenging entity to diagnose; however, it should be considered in cases of deep vein thrombosis of the subclavian vein and confirmed by angiography after a thrombectomy.
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Affiliation(s)
| | - Adrian Torres-Parlange
- Hospital General "5 de Diciembre" of the Security Institute for the Service of State Workers, México
| | - Jorge Sotelo-Carbajal
- Hospital General Regional No. 1 Tijuana, Baja California, Mexican Institute of Social Security, México
| | | | - Arnold García-Ledezma
- Hospital General Regional No. 1 Tijuana, Baja California, Mexican Institute of Social Security, México
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Fouasson-Chailloux A, Jager T, Daley P, Falcone A, Duysens C, Estoppey D, Merle M, Pomares G. Possible role of the botulinum toxin in the management of neurogenic thoracic outlet syndrome: a systematic review. Eur J Phys Rehabil Med 2023; 59:706-713. [PMID: 37737048 PMCID: PMC10797639 DOI: 10.23736/s1973-9087.23.07815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/31/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Thoracic outlet syndrome (TOS) is related to the compression and/or the traction of the upper-limb neurovascular bundle, responsible for a chronic painful impairment. Neurogenic TOS (NTOS) is the most common manifestation. It remains a challenging diagnosis and its treatment is also difficult. Botulinum toxin (BTX) has been described to help both the diagnosis and the symptoms improvement. EVIDENCE ACQUISITION A systematic literature research was performed using PubMed, ScienceDirect, and Embase databases to collect studies reporting the use of BTX in NTOS management. We followed the PRISMA guidelines, and the included studies were evaluated using the GRADE approach. EVIDENCE SYNTHESIS We included 10 original articles representing 555 patients. Various outcomes were considered, and results varied from a study to another. Symptoms relief varied from an absence of BTX effectiveness to 84.1% of improvement; relief duration was also reported from none to 88 days. BTX injections were debatable predictors of surgical procedure successes due to low evidence. There was a huge gap between the studies concerning side-effects of the BTX procedures, from none to 100% of the patients. CONCLUSIONS There is no evidence for considering BTX injection as a validated tool for the management of NTOS. There might be a slight effect on symptoms, but outcomes are very variable, which prevents further interpretations. The use of BTX should be evaluated in larger prospective cohorts with more standardized outcomes.
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Affiliation(s)
- Alban Fouasson-Chailloux
- European Hand Institute, Luxembourg, Luxembourg -
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg -
- Service of Motor and Respiratory Physical and Rehabilitation Medicine, Nantes University, CHU Nantes, Nantes, France -
- Regional Institute of Sports Medicine (IRMS), St Jacques Hospital, Nantes, France -
| | - Thomas Jager
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Pauline Daley
- Service of Motor and Respiratory Physical and Rehabilitation Medicine, Nantes University, CHU Nantes, Nantes, France
- Regional Institute of Sports Medicine (IRMS), St Jacques Hospital, Nantes, France
| | - Andrea Falcone
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Christophe Duysens
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Daniel Estoppey
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Michel Merle
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Germain Pomares
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
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8
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Ureña A, Déniz C, Muñoz A, Macía I, Rivas F, Ramos R. Uniportal robotic-assisted thoracoscopic surgery: resection of the first rib. Ann Cardiothorac Surg 2023; 12:62-63. [PMID: 36793986 PMCID: PMC9922766 DOI: 10.21037/acs-2022-urats-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/18/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Déniz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Anna Muñoz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Ivan Macía
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
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9
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Perdikakis M, Sinou N, Angelis S, Tsakotos G, Mariolis-Sapsakos T, Piagkou M, Filippou D. Anatomy and Pathogenesis of Vascular Thoracic Outlet Syndrome. Cureus 2023; 15:e34470. [PMID: 36874699 PMCID: PMC9981236 DOI: 10.7759/cureus.34470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
The current literature review article describes the anatomy and pathogenesis of the vascular nature of thoracic outlet syndrome (TOS), as well as gathers the latest and most important information concerning its diagnostic methods and treatment. This syndrome's subcategory includes the venous and the arterial. Data for this review was accumulated through the PubMed database in which only scientific studies published in the last decade (2012-2022) were searched. PubMed offered 347 results, of which 23 were judged suitable and used. Non-invasive methods both for the diagnosis and the treatment of vascular TOS are gaining ground. Medicine, at this point, finds itself on the verge of slowly putting aside the previous invasive gold-standard methods, to be used only in the most urgent situations. The vascular thoracic outlet condition is a rare form of TOS but is also the most trouble-causing one and the deadliest. Fortunately, it can be more efficiently managed because of the current medical innovations. However, further research is needed to establish their already confirmed effectiveness, so they can be even more widely trusted and used.
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Affiliation(s)
- Miltiadis Perdikakis
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Nikoleta Sinou
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Stavros Angelis
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - George Tsakotos
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - Maria Piagkou
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Dimitrios Filippou
- Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Relationships between the Clinical Test Results and Neurophysiological Findings in Patients with Thoracic Outlet Syndrome. Bioengineering (Basel) 2022; 9:bioengineering9100598. [PMID: 36290565 PMCID: PMC9598481 DOI: 10.3390/bioengineering9100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Abstract
A thoracic outlet syndrome (TOS) is the type of brachial plexus disorder most difficult to objectively assess using a clinical examination and differential diagnosis. Its symptoms can be frequently misdiagnosed, especially among others with cervical disc-root conflicts, plexopathies, and peripheral neuropathies. In this study, we aim to identify the correlations between positive Doppler ultrasonography results indicating pathological changes in the subclavian flow velocity, clinical tests, and chosen clinical neurophysiology recordings as proposed alternative or supplementary diagnostic tools for evaluating TOS patients. Sixty TOS patients with positive Doppler ultrasonography and Roos test results and sixty healthy people as a control group were bilaterally examined, and the results were compared. Pain intensity was assessed using a visual analogue scale (VAS). Sensory perceptions within C4–C8 dermatomes were assessed with Von Frey filament (FvF) tests. The activity of motor units in the proximal and distal muscles of the upper extremities was evaluated using surface electromyography (sEMG) during maximal contractions before and after a provocative raised hands test (RHT). An electroneurography (ENG) was used to evaluate the transmission of nerve impulses peripherally. Motor evoked potential (MEP) recordings, induced by the over-vertebral magnetic stimulation of the C5–C7 neuromeres, were used to examine motor transmissions from the cervical motor centres to the upper extremities muscles. The results revealed a relationship between positive Doppler test scores and pathological changes in the subclavian flow velocity through the results of the following diagnostic tools: a VAS score of 1.9 was detected on average, superficial sensory perception abnormalities were found in the innervation areas of the ulnar nerves detected by FvF tests, a decrease in the amplitudes of sEMG recordings was seen in distal rather than proximal muscles (especially following the RHT), a decrease in the motor and sensory peripheral transmissions of nerve impulses in the median, ulnar and cutaneous anterobrachial median nerves was seen, as well as MEP amplitudes recorded from the abductor pollicis brevis muscle. The provocative RHT combined with sEMG and MEP recordings can be considered accurate and objective clinical neurophysiology tools that could supplement the commonly used clinical tests. Such an approach may result in a more precise neurogenic TOS diagnostic algorithm.
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Milenovic N, Klasnja A, Skrbic R, Popovic Petrovic S, Lukac S, Devecerski G. Sleep Problems and Disabilities of the Arm, Shoulder, and Hand in Persons with Thoracic Outlet Syndrome-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12486. [PMID: 36231785 PMCID: PMC9566055 DOI: 10.3390/ijerph191912486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Thoracic outlet syndrome (TOS) arises as a result of a specific relationship among the anatomical structures that may cause compression in the muscles, nerves, and/or blood vessels in the neck, thereby compromising the local circulation. The aim of the current study was to establish the presence of sleep disturbance and disability in the shoulder, arm, and hand in individuals affected by TOS, as well as to ascertain if there are any differences in these findings relative to TOS-free individuals. The study sample comprised 82 TOS patients and 81 TOS-free individuals aged 19-66 years. Data were gathered by administering the Disabilities of the Arm, Shoulder, and Hand (DASH) and Pittsburgh Sleep Quality Index (PSQI) instruments. The results showed that both the DASH (t = -13.21, p < 0.001) and PSQI (t = -7.27, p < 0.001) scores obtained by the TOS group were higher relative to the controls and were strongly and positively correlated (ρ = 0.58, p < 0.01). As positive DASH scores may be indicative of TOS, they signal the need for further diagnostic evaluations. In individuals in whom TOS is already diagnosed, high DASH scores imply that further sleep quality assessments are required, as compromised sleep patterns may undermine quality of life.
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Affiliation(s)
- Natasa Milenovic
- Faculty of Medicine, University of Novi Sad, 21 137 Novi Sad, Serbia
- The Special Hospital for Rheumatic Diseases, 21 137 Novi Sad, Serbia
| | | | - Renata Skrbic
- Faculty of Medicine, University of Novi Sad, 21 137 Novi Sad, Serbia
| | - Svetlana Popovic Petrovic
- Faculty of Medicine, University of Novi Sad, 21 137 Novi Sad, Serbia
- Oncology Institute of Vojvodina, 21 204 Sremska Kamenica, Serbia
| | - Sonja Lukac
- Faculty of Medicine, University of Novi Sad, 21 137 Novi Sad, Serbia
- Center of Radiology, University Clinical Center of Vojvodina, 21 137 Novi Sad, Serbia
| | - Gordana Devecerski
- Faculty of Medicine, University of Novi Sad, 21 137 Novi Sad, Serbia
- Department at the Clinic for Medical Rehabilitation, University Clinical Center of Vojvodina, 21 137 Novi Sad, Serbia
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Jammeh ML, Yang A, Abuirqeba AA, Ohman JW, Thompson RW. Reoperative Brachial Plexus Neurolysis After Previous Anatomically Complete Supraclavicular Decompression for Neurogenic Thoracic Outlet Syndrome: A 10-Year Single-Center Case Series. Oper Neurosurg (Hagerstown) 2022; 23:125-132. [PMID: 35838452 PMCID: PMC9287103 DOI: 10.1227/ons.0000000000000252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/16/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Optimal management of recurrent neurogenic thoracic outlet syndrome (NTOS) remains a considerable challenge. OBJECTIVE To assess the safety and effectiveness of reoperative brachial plexus neurolysis in patients with recurrent NTOS. METHODS From 2009 to 2019, 85 patients underwent reoperative supraclavicular brachial plexus neurolysis for recurrent NTOS after a previous anatomically complete supraclavicular decompression. Data from a prospectively maintained database were analyzed retrospectively. RESULTS The mean patient age at reoperation was 36.9 ± 1.3 (range 15-64) years, 75% were female, and the interval after previous primary operation was 2.5 ± 0.2 years. Intervening injury had precipitated recurrent NTOS in 14 patients (16%), and the mean Disability of the Arm, Shoulder, and Hand (QuickDASH) score before reoperation was 65.2 ± 2.6, reflecting substantial disability. Operative findings consisted of dense fibrous scar tissue surrounding/encasing the brachial plexus. Compared with the previous primary operations, reoperations had a shorter operative time (198 ± 4 vs 161 ± 5 minutes, P < .01) and hospital stay (4.4 ± 0.2 vs 3.6 ± 0.1 days, P < .01), but there were no significant differences in the frequency of prolonged hospitalization (7.1% vs 4.7%), early reoperation (3.5% vs 1.2%), or 30-day hospital readmission (8.2% vs 7.1%). During a median follow-up of 4.8 years, QuickDASH scores improved by 23.3 ± 2.6 (34.2% ± 3.6%; P < .01) and patient-rated outcomes were excellent in 24%, good in 42%, fair in 26%, and poor in 8%. CONCLUSION Reoperative supraclavicular brachial plexus neurolysis is technically challenging but safe and effective treatment for recurrent NTOS, with significant improvements in symptoms and function. Diminishing perineural scar tissue development and avoiding secondary injury would likely decrease the need for reoperations.
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Affiliation(s)
- Momodou L. Jammeh
- The Center for Thoracic Outlet Syndrome and the Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA;,Section of Vascular Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alexander Yang
- The Center for Thoracic Outlet Syndrome and the Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA;,Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA;,Division of Neurosurgery, Department of Surgery, Creighton University, Omaha, Nebraska, USA
| | - Ahmmad A. Abuirqeba
- The Center for Thoracic Outlet Syndrome and the Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA;,Section of Vascular Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - J. Westley Ohman
- The Center for Thoracic Outlet Syndrome and the Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA;,Section of Vascular Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert W. Thompson
- The Center for Thoracic Outlet Syndrome and the Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA;,Section of Vascular Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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13
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Huang Y, Abad-Santos M, Iyer RS, Monroe EJ, Malone CD. Imaging to intervention: Thoracic outlet syndrome. Clin Imaging 2022; 89:23-36. [PMID: 35689965 DOI: 10.1016/j.clinimag.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/21/2022] [Accepted: 06/06/2022] [Indexed: 11/03/2022]
Abstract
Thoracic outlet syndrome (TOS) is a clinical disorder resulting from compression of the neurovascular bundle of the lower neck and upper chest. TOS can be categorized into neurogenic, venous, and arterial subtypes which result from anatomical compression of the brachial plexus, subclavian vein, and subclavian artery, respectively. This can lead to neurogenic pain as well as vascular injury with thrombosis and thromboembolism. Interventional and diagnostic radiologists play a critical role in the imaging diagnosis and treatment of vascular TOS. Prompt imaging and endovascular management with surgical collaboration has been shown to provide the most successful and long-lasting clinical outcomes, from vessel patency to symptom relief. In this article, we review the anatomy and clinical presentations of TOS as well as the initial imaging modalities used for diagnosis. Furthermore, we detail the role of the diagnostic and interventional radiologist in the management of TOS, including pre-procedure and endovascular interventions, along with medical and surgical treatments. PRECIS: Diagnostic and Interventional Radiologists play a key role in diagnosis and management of vascular thoracic outlet syndromes and are critical for timely and successful outcomes.
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Affiliation(s)
- Yijin Huang
- Emory University, Atlanta, GA, United States of America
| | - Matthew Abad-Santos
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Ramesh S Iyer
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Eric J Monroe
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Christopher D Malone
- Mallinckrodt Institute of Radiology at Washington University School of Medicine, St. Louis, MO, United States of America.
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Luu D, Seto R, Deoraj K. Exercise rehabilitation for neurogenic thoracic outlet syndrome: a scoping review. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2022; 66:43-60. [PMID: 35655698 PMCID: PMC9103635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Exercise rehabilitation has been proposed for the management of Neurogenic Thoracic Outlet Syndrome (NTOS). To date there have been no reviews of the literature regarding exercise rehabilitation for NTOS and their proposed clinical rationale. Understanding various exercise protocols and their clinical rationale may help guide rehabilitation clinicians in their exercise selection when managing NTOS. A scoping review was conducted on exercise rehabilitation for NTOS from inception to March 2021 in the PubMed database. Forty-seven articles consisting of literature reviews, non-randomized control trials, prospective and retrospective cohort studies, case series, case studies and clinical commentaries met the inclusion criteria. This scoping review provides a broad overview of the most common exercise protocols that have been published and examines the purported clinical rationale utilized in the management of NTOS.
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Affiliation(s)
- Derick Luu
- Division of Research and Innovation, Canadian Memorial Chiropractic College
- School of Rehabilitation Science, McMaster University
| | - Richard Seto
- Division of Research and Innovation, Canadian Memorial Chiropractic College
| | - Kevin Deoraj
- Division of Research and Innovation, Canadian Memorial Chiropractic College
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15
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Camporese G, Bernardi E, Venturin A, Pellizzaro A, Schiavon A, Caneva F, Strullato A, Toninato D, Forcato B, Zuin A, Squizzato F, Piazza M, Stramare R, Tonello C, Di Micco P, Masiero S, Rea F, Grego F, Simioni P. Diagnostic and Therapeutic Management of the Thoracic Outlet Syndrome. Review of the Literature and Report of an Italian Experience. Front Cardiovasc Med 2022; 9:802183. [PMID: 35391849 PMCID: PMC8983020 DOI: 10.3389/fcvm.2022.802183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
The Thoracic Outlet Syndrome is a clinical potentially disabling condition characterized by a group of upper extremity signs and symptoms due to the compression of the neurovascular bundle passing through the thoracic outlet region. Because of the non-specific nature of signs and symptoms, to the lack of a consensus for the objective diagnosis, and to the wide range of etiologies, the actual figure is still a matter of debate among experts. We aimed to summarize the current evidence about the pathophysiology, the diagnosis and the treatment of the thoracic outlet syndrome, and to report a retrospective analysis on 324 patients followed for 5 years at the Padua University Hospital and at the Naples Fatebenefratelli Hospital in Italy, to verify the effectiveness of a specific rehabilitation program for the syndrome and to evaluate if physical therapy could relieve symptoms in these patients.
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Affiliation(s)
- Giuseppe Camporese
- Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Enrico Bernardi
- Department of Emergency and Accident Medicine, Hospital of Treviso, Treviso, Italy
| | - Andrea Venturin
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Alice Pellizzaro
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Alessandra Schiavon
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Francesca Caneva
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Alessandro Strullato
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Daniele Toninato
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Beatrice Forcato
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Andrea Zuin
- Thoracic Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Francesco Squizzato
- Vascular Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
- Department of Medicine DIMED, Institute of Radiology, Padua University Hospital, Padua, Italy
| | - Michele Piazza
- Vascular Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
- Department of Medicine DIMED, Institute of Radiology, Padua University Hospital, Padua, Italy
| | - Roberto Stramare
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Chiara Tonello
- Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Pierpaolo Di Micco
- Department of Internal Medicine and Emergency Room, Naples Buon Consiglio Fatebenefratelli Hospital, Naples, Italy
| | - Stefano Masiero
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Federico Rea
- Thoracic Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Franco Grego
- Vascular Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
- Department of Medicine DIMED, Institute of Radiology, Padua University Hospital, Padua, Italy
| | - Paolo Simioni
- Department of Internal Medicine, General Medicine Unit, Thrombotic and Haemorrhagic Disorders Unit, University Hospital of Padua, Padua, Italy
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Gkikas A, Lampridis S, Patrini D, Kestenholz PB, Azenha LF, Kocher GJ, Scarci M, Minervini F. Thoracic Outlet Syndrome: Single Center Experience on Robotic Assisted First Rib Resection and Literature Review. Front Surg 2022; 9:848972. [PMID: 35350142 PMCID: PMC8957785 DOI: 10.3389/fsurg.2022.848972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThoracic outlet syndrome (TOS) is a pathological condition caused by a narrowing between the clavicle and first rib leading to a compression of the neurovascular bundle to the upper extremity. The incidence of TOS is probably nowadays underestimated because the diagnosis could be very challenging without a thorough clinical examination along with appropriate clinical testing. Beside traditional supra-, infraclavicular or transaxillary approaches, the robotic assisted first rib resection has been gaining importance in the last few years.MethodsWe conducted a retrospective cohort analysis of all patients who underwent robotic assisted first rib resection due to TOS at Lucerne Cantonal Hospital and then we performed a narrative review of the English literature using PubMed, Cochrane Database of Systematic Reviews and Scopus.ResultsBetween June 2020 and November 2021, eleven robotic assisted first rib resections were performed due to TOS at Lucerne Cantonal Hospital. Median length of stay was 2 days (Standard Deviation: +/– 0.67 days). Median surgery time was 180 min (Standard Deviation: +/– 36.5). No intra-operative complications were reported.ConclusionsRobotic assisted first rib resection could represent a safe and feasible option in expert hands for the treatment of thoracic outlet syndrome.
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Affiliation(s)
- Andreas Gkikas
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, United Kingdom
| | - Savvas Lampridis
- Department of Thoracic Surgery, 424 General Military Hospital, Thessaloniki, Greece
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals, London, United Kingdom
| | - Peter B. Kestenholz
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Luis Filipe Azenha
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Gregor Jan Kocher
- Division of Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Scarci
- Department of Thoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Fabrizio Minervini
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
- *Correspondence: Fabrizio Minervini
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Ferris S, Lonie S. Bilateral Thoracic Outlet Syndrome from Anomalous 8th Cervical Vertebrae Ribs. J Brachial Plex Peripher Nerve Inj 2022; 17:e30-e32. [PMID: 35860506 PMCID: PMC9293487 DOI: 10.1055/s-0042-1753541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/09/2022] Open
Abstract
Thoracic outlet syndrome (TOS) is a group of diverse disorders resulting from compression of neurovascular structures as they pass from the lower neck to upper limb. Neurological symptoms, such as pain, weakness, or paraesthesia, are much more common than vascular symptoms such as pallor or venous congestion. Anatomical abnormalities can contribute to this condition. Thirty percent of patients with TOS can have a cervical rib, arising from the transverse process of the 7th cervical vertebra, compared with 1% of the general population. We report the first case in the literature of neurogenic TOS from a cervical rib arising from a supernumerary 8th cervical vertebra. This patient had immediate improvement in TOS symptoms following scalene muscle surgery and resection of cervical and first thoracic ribs.
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Affiliation(s)
- Scott Ferris
- Department of Plastic, Hand and Faciomaxillary Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Sarah Lonie
- Department of Plastic, Hand and Faciomaxillary Surgery, Alfred Health, Melbourne, Victoria, Australia
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Storari L, Signorini M, Barbari V, Mourad F, Bisconti M, Salomon M, Rossettini G, Maselli F. A Thoracic Outlet Syndrome That Concealed a Glioblastoma. Findings from a Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57090908. [PMID: 34577831 PMCID: PMC8468880 DOI: 10.3390/medicina57090908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
Background: Glioblastoma is the most frequent and aggressive malignant brain tumor among adults. Unfortunately, its symptoms can vary considerably depending on the size, location and the anatomic structures of the involved brain. Case report: A 58-year-old male amateur cyclist who suffered from sharp arm pain was examined for a thoracic outlet syndrome due to a previous clavicle fracture. Because of ambiguous results of the neck and nerve plexus imaging, he was referred to a neurosurgeon who properly suspected a brain tumor. The neuroimaging of the brain shown a 3 cm disploriferative mass with a blood enhancement within the left parietal lobe. The mass was urgently removed, and its histologic analysis stated a grade 4 glioblastoma. Conclusion: This case report highlights the differential diagnosis process and the teamwork approach needed to diagnose a rare presentation of a brain glioblastoma, which started its symptoms mimicking a thoracic outlet syndrome caused by a previous bone fracture.
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Affiliation(s)
- Lorenzo Storari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DI-NOGMI), Campus of Savona—University of Genova, Via Magliotto 2, 17100 Savona, Italy; (L.S.); (V.B.)
| | - Manuel Signorini
- Department of Radiology, ULSS 9 Scaligera, Mater Salutis Hospital, 37045 Legnago, Italy;
| | - Valerio Barbari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DI-NOGMI), Campus of Savona—University of Genova, Via Magliotto 2, 17100 Savona, Italy; (L.S.); (V.B.)
| | - Firas Mourad
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy; (F.M.); (M.S.)
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, L-4671 Differdange, Luxembourg
| | - Mattia Bisconti
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, c/o Cardarelli Hospital, C/da Tappino, 86100 Campobasso, Italy;
| | - Mattia Salomon
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy; (F.M.); (M.S.)
| | | | - Filippo Maselli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DI-NOGMI), Campus of Savona—University of Genova, Via Magliotto 2, 17100 Savona, Italy; (L.S.); (V.B.)
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy
- Correspondence:
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