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Neurological thoracic outlet syndrome12/15/2023 ![]() ![]() This clinical phenotype has also been referred to as the Gilliatt-Sumner hand ( 07).ĭisputed thoracic outlet syndrome. Sensory features in the form of pain, paresthesias, or numbness are usually present and involve the medial forearm or hand ( 28) they can, however, be subtle and require a careful sensory exam to demonstrate a deficit. Weakness is present but less pronounced in ulnar-innervated hand and forearm muscles and least in radial-innervated forearm muscles. Patients present with intrinsic hand muscle weakness, loss of dexterity, and wasting, primarily of the median-innervated thenar muscles, which are innervated primarily by T1>C8 axons ( 28). The motor abnormalities are usually more pronounced and may be quite advanced at presentation because of the indolent progression of this disorder. True neurogenic thoracic outlet syndrome has clear and well-accepted clinical and electrophysiologic features, reflecting involvement of T1>C8 sensory and motor fibers. True neurogenic thoracic outlet syndrome will usually present with unilateral symptoms and signs, often initiated with pain. True neurogenic thoracic outlet syndrome. The medial cord of the brachial plexus passes behind the midshaft of the clavicle and is highly susceptible to injury.Venous thoracic outlet syndrome results from thrombosis of the axillosubclavian vein at-risk individuals include athletes and persons with hypercoagulable states.Arterial thoracic outlet syndrome often coexists with neurogenic thoracic outlet syndrome, and symptoms relate to limb ischemia.Typical symptoms and signs of true neurogenic thoracic outlet syndrome include sensory symptoms over the medial hand or forearm and intrinsic hand muscle weakness and atrophy, disproportionately involving the thenar eminence motor signs predominate.Terms used in the past for thoracic outlet syndrome have included cervical rib and band syndrome, scalenus anticus syndrome, costoclavicular syndrome, pectoralis minor syndrome, and hyperabduction syndrome, among others ( 04 05). The term "thoracic outlet syndrome" was coined by Peet in 1956, although his definition encompassed all the forms and causes of neurovascular compression at the neck ( 19). In 1910, Murphy performed the first rib resection and reported improvement ( 22). Over time, greater recognition of both vascular and neurologic types of thoracic outlet syndromes developed slowly until the early 1900s, when detailed clinical studies were presented. The first notion of thoracic outlet syndrome may have occurred in the 2nd century AD with the mention of a cervical rib by Galen ( 22). This nosology has resulted in controversy and debate over diagnosis and treatment. The term thoracic outlet syndrome is a misnomer as there are several forms of this syndrome, and the term thoracic outlet syndromes should be used instead. Disputed thoracic outlet syndrome is best considered a cervicoscapular pain syndrome.Sensory symptoms over the medial hand or forearm and intrinsic hand muscle weakness and atrophy, disproportionately involving the thenar eminence, are typical symptoms and signs of true neurogenic thoracic outlet syndrome.The syndrome can result from an anomalous fibrous band stretching from an abnormally elongated C7 transverse process or a cervical rib, to the first thoracic rib, impinging on the lower trunk of the brachial plexus or T1 spinal root. True neurogenic thoracic outlet syndrome is extremely rare.The thoracic outlet syndromes include true neurogenic, disputed, arterial, venous, and traumatic neurovascular subtypes.They can be characterized by their respective clinical manifestations, etiologies, electrodiagnostic and imaging features, and managements. Subtypes of thoracic outlet syndromes include true neurogenic, disputed, arterial, venous, and traumatic neurovascular. The thoracic outlet syndromes are a heterogeneous group of distinct disorders that share a common feature: the compression of neurovascular structures in the thoracic outlet. ![]()
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