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Algorithm for Surgical Decision Making in Patients with thoracic outlet syndrome

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World Journal of Cardiovascular Surgery 2022年第10期12卷 235-244页

作者： Farid Gharagozloo Institute for Advanced thoracic Surgery Orlando USA University of Central Florida College of Medicine Orlando USA University of Central Florida Lake Nona Medical Center Orlando USA

Purpose: Historically the classification of thoracic outlet syndrome (TOS) has been based on symptoms rather than the underlying pathology. Therefore, TOS has been classified into Neurogenic (NTOS), Venous (VTOS or Paget Schroetter syndrome) and Arterial (ATOS) subgroups. This classification has resulted in confusion among medical practitioners, difficulty in making the diagnosis, and the poor results with surgical intervention. Methods: The published papers from PubMed on the newer understanding of the pathogenesis and the surgical treatment of TOS were reviewed. Results: More recently TOS has been classified based on the underlying pathologic entity. Based on this classification, patients who are suspected of having TOS should be classified as having 1. Cervical Rib Disease (CRD), or 2. TOS as the result of “Subclavian Vein Compression syndrome”. This classification has resulted in more accurate diagnosis, better patient selection for surgery, and excellent surgical results. This paper outlines the algorithm for making the appropriate diagnosis in patients who present with neurovascular symptoms of the upper extremity and the selection of the appropriate patients for surgery. Conclusion: Based on the algorithm for surgical decision making, patients with Cervical Rib Disease should undergo cervical exploration and resection of the pathologic entity which results in compression of the brachial plexus or the subclavian artery in the neck. Patients with thoracic outlet syndrome who are found to have extrinsic compression of the subclavian vein by a pathologic tubercle at the sternocostal joint on Multiphasic MRA should undergo robotic first rib resection.

关键词： thoracic outlet syndrome Robotic First Rib Resection Neurogenic TOS Venous TOS Arterial TOS Algorithm

Essentials of thoracic outlet syndrome:A narrative review

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World Journal of Clinical Cases 2021年第21期9卷 5804-5811页

作者： Min Cheol Chang Du Hwan Kim Department of Rehabilitation Medicine College of MedicineYeungnam UniversityDaegu 42415South Korea Department of Physical Medicine and Rehabilitation College of MedicineChung-Ang UniversitySeoul 06973South Korea

thoracic outlet syndrome(TOS)is a group of diverse disorders involving compression of the nerves and/or blood vessels in the thoracic outlet *** results in pain,numbness,paresthesia,and motor weakness in the affected upper *** reviewed the pathophysiology,clinical evaluation,differential diagnoses,and treatment of *** is usually classified into three types,neurogenic,venous,and arterial,according to the primarily affected *** true neurogenic and disputed TOS are considered neurogenic *** identifying the causative lesions is complex,detailed history taking and thorough clinical investigation are *** and imaging studies are helpful for excluding other possible disorders and confirming the diagnosis of true neurogenic *** existence of a disputed TOS remains *** physicians tend to be skeptical about the existence of disputed TOS,but thoracic surgeons argue that disputed TOS is *** who encounter patients with TOS need to understand its key features to avoid misdiagnosis and provide appropriate treatment.

关键词： Brachial plexus Diagnosis Review thoracic outlet syndrome Treatment Neuromuscular lesions

A Single Case Study-Acupuncture in the Treatment of thoracic outlet syndrome

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A Single Case Study-Acupuncture in the Treatment of Thoracic...

Upper extremity deep vein thrombosis:An intensivist’s perspective

第十四届全国中药和天然药物学术研讨会

作者： Yung Tat To Lei Li The University of Hong Kong

Background thoracic outlet syndrome is a syndrome involving compression at the superior thoracic outlet,resulting from excess pressure placed on a neurovascular bundle passing between the anterior scalene and middle scalene *** can be caused from trauma disease and congenital *** on nerves（brachial plexus）can cause a vague,aching pain in the neck,shoulder and arm,or even cause numbness on the inside of the forearm and the 4th,5th *** is effective in managing pain problem and can be one of the effective methods for managing thoracic outlet *** Description This study reports a 74 years old man presented with 2-years neck pain,and right upper limb numbness and pain,Adson’s Test showed positive result and was diagnosed as thoracic outlet *** patient had good past health with mild *** was red with thin white coating,pulse was *** The patient was treated with acupuncture together with electrical ***16,LI17,LI18,ST12,EX-HN15 and Ah-Shi points were chosen and the EA stimulation was given at discontinuous wave with frequency of 60Hz for *** a week,total end up with 10times *** The patient showed significant improvement after 1 month treatment,he felt the pain was gone but still presented with mild numbness over his 4th,5th *** disappeared after *** Nowadays,conservative treatments such as medication,rest,physical therapy are mainly involved for thoracic outlet *** article reveals that acupuncture can be another effective treatment for thoracic outlet ***,more research is necessary to investigate the effect of acupuncture for this kind of problem.

关键词： thoracic outlet syndrome Acupuncture Case report

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World Journal of Critical Care Medicine 2023年第3期12卷 130-138页

作者： Omender Singh Deven Juneja Institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India

Upper extremity deep vein thrombosis(UEDVT)is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit *** cancer incidence,prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of *** is also associated with high rates of complications like pulmonary embolism,post-thrombotic syndrome and recurrent *** prediction scores and D-dimer may not be as useful in identifying UEDVT;hence,a high suspicion index is required for *** ultrasound is commonly employed for diagnosis,but other tests like computed tomography and magnetic resonance imaging venography may also be required in some *** venography is rarely used in patients with clinical and ultrasound findings *** therapy alone is sufficient in most patients,and thrombolysis and surgical decompression is seldom *** outcome depends on the cause and underlying comorbidities.

关键词： Catheter associated deep vein thrombosis Pacemaker associated deep vein thrombosis Paget-von Schröetter syndrome thoracic outlet syndrome Upper extremity deep vein thrombosis