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Clinical Evaluation
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Long used in the evaluation of suspected thoracic outlet syndrome, these tests are nonspecific and unreliable. With the patient sitting erect, the upper extremities at the side (Adson) or symptomatic upper extremity abducted and extended (hyperabduction), the radial pulse is palpated. Each test is positive if the pulse disappears, and paraesthesia develops in the hand of the symptomatic extremity. Also, an upper limb tension test is sensitive for diagnosing thoracic outlet syndrome (Figure 2.4).Tinel's sign
Examine the eyes
Published in Hani TS Benamer, Neurology for MRCP PACES, 2019
Q: What are the causes of Horner’s syndrome? Isolated painless Horner’s syndrome could be idiopathic.Pancoast’s syndrome as a result of apical lung malignancy.Trauma or surgery, such as thyroid surgery.Thoracic outlet syndrome.Painful Horner’s syndrome could be associated with migraine and carotid artery dissection. Other causes include syringomyelia, nasopharyngeal cancer and lateral medullary syndrome.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The relationships of the roots, trunks, and divisions of the brachial plexus to the scalene muscles, 1st rib, and clavicle are important. Compression within a fixed space (the thoracic outlet) may lead to symptoms resulting from compression of the brachial plexus and/or nearby vascular structures (subclavian artery and vein). This is known as the thoracic outlet syndrome.
Performance in major league baseball pitchers after surgical treatment of thoracic outlet syndrome
Published in The Physician and Sportsmedicine, 2022
Michael J. Gutman, Brian S. Gutman, Christopher D. Joyce, Jacob M. Kirsch, Matthew B. Sherman, Surena Namdari
Thoracic outlet syndrome (TOS) is a rare condition that occurs when there is compression of the subclavian artery, subclavian vein, or the brachial plexus [1–4]. Though multiple compressive structures are implicated in TOS, hypertrophic scalene or pectoralis minor muscles are most commonly seen in overhead athletes [1,5–8]. TOS can further be subdivided based on the compromised neurovascular structures such as arterial, venous, or neurogenic. Most cases of TOS are neurogenic, composing 95% of the cases, followed by venous thoracic outlet obstruction (VTOS) comprising 4% of the cases [2]. The C8 and T1 nerve roots are most commonly affected in neurogenic thoracic outlet syndrome (NTOS), causing paresthesia, weakness, and pain commonly involving multiple fingers. Symptoms in NTOS are typically worse with arm elevation [9]. These abnormal findings are not necessarily in a standard dermatomal pattern but rather to a region, such as the arm, hands, or fingers [3,10]. VTOS may present as either acute thrombosis or chronic intermittent obstruction [6,7].
Familial predisposition of thoracic outlet syndrome: does a familial syndrome exist? Report of cases and review of literature
Published in Acta Chirurgica Belgica, 2021
Jens Goeteyn, Niels Pesser, Bart van Nuenen, Marc van Sambeek, Joep Teijink
These cases show a familial predisposition of thoracic outlet syndrome. A review of literature (Medline, EMBASE) could only identify two earlier case reports of familial predisposition of thoracic outlet syndrome [7,8]. One article reports on three patients in the same family (mother, daughter and aunt) diagnosed and treated for VTOS. They were all treated with a trans-axillary first rib resection with good results [8]. There is no description of possible anatomical variations of mechanism that caused three patients of the same family to end up with VTOS. Another case report describes the presence of CRs (described as apophysomegaly of the seventh cervical vertebra) in 13 family members of the same household (mother and 12 out of 13 children). All patients received physiotherapy and pain relief. Three children were additionally treated with TOD with resection of the CR [7].
Paget-Schroetter Syndrome: a case report of diagnosis, treatment, and outcome in a healthy 18-year-old athletic swimmer
Published in The Physician and Sportsmedicine, 2020
Almaan El-Attrache, Eric Kephart
An 18 year-old right-hand-dominant female, who is a college freshman freestyle-swimmer, presented with one week of diffuse pain and swelling of her right arm after intense swimming in a meet. Evaluation by a trainer suggested she may have thoracic outlet syndrome, and she was treated conservatively. Over the next two weeks, she continued to experience swelling and purplish color changes in her arm, exacerbated by swimming and weightlifting. Because of her persistent symptoms, the athlete was evaluated in the university athletic training room by a primary care sports medicine physician. She was noted to have no significant past medical history and her only medication was an oral low-dose combined oral contraceptive (norgestimate-ethinyl estradiol .18/.215/.25 mg-25 mcg daily). Examination revealed diffuse mild upper arm non-pitting edema (particularly of the biceps), tenderness of the right trapezius, no visible upper extremity discoloration, no visible venous distention, full neck and shoulder range-of-motion without pain, 2/4 (normal) radial and ulnar pulses, negative Adson’s test, negative Roos test, and 5/5 (normal) right upper extremity strength. DVT of the right upper extremity was suspected.