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County outlet syndrome thoracic

This article has multiple issues.Please help improve it or discuss these issues on the talk page.It needs additional citations for verification.Tagged since November 2009.It may contain original research.Tagged since November 2009.The right brachial plexus, viewed from in front.In thoracic outlet syndrome there is compression of the brachial plexus or subclavian vessels in their passage from the cervical and upper thoracic area toward the axilla and proximal arm.

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The anterior supraclavicular neurosurgical procedure is used to treat certain refractory cases.Thoracic Outlet Syndrome (TOS) is a syndrome involving compression at the superior thoracic outlet[1] wherein excess pressure placed on a neurovascular bundle passing between the anterior scalene and middle scalene muscles.[2] It can affect one or more of the brachial plexus (nerves that pass into the arm from the neck), the subclavian artery, and - rarely - the vein, which does not normally pass through the scalene hiatus (blood vessels as they pass between the chest and upper extremity.

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inmate searchRarely a Pancoast tumor (a rare form of lung cancer in the apex of the lung) may be the cause.TOS may occur due to a positional cause - for example, by abnormal compression from the clavicle (collarbone) and shoulder girdle on arm movement.There are also several static forms, caused by abnormalities, enlargement, or spasm of the various muscles surrounding the arteries, veins, and/or brachial plexus, a fixation of a first rib, or a cervical rib.
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Common orthopaedic tests used are the Adson's test, the Costoclavicular Manoeuvre, and the Hands-Up test of East.
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Careful examination and X-ray are required to differentially diagnose between the positional and static aetiologies, first rib fixations, scalene muscle spasm, and a cervical rib or fibrous band.
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1.1 By structures affected & symptomatology 1.3 By structure causing constriction There are three main types of TOS, named according to the cause of the symptoms; however these 3 classifications have been coming into disfavor because TOS can involve all 3 types of compression to various degrees.
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The compression can occur in three anatomical structures (arteries, veins and nerves), can be isolated, or - more commonly - two or three of the structures are compressed to greater or lesser degrees.

In addition, the compressive force(s) can be of different magnitude in each affected structure.GDC b75 pansat bin file.
Therefore, symptoms can be protean.[3] http://www.tos-syndrome.
com/old1/newpage12.htm[4] Neurogenic TOS includes disorders produced by compression of components of the brachial plexus nerves.
The neurogenic form of TOS accounts for 95% of all cases of TOS.
[5] Arterial TOS is due to compression of the subclavian artery.
[5] Venous TOS is due to compression of the subclavian vein.[5] There are many causes of TOS.
The most frequent cause is trauma, either sudden (as in a clavicle fracture caused by a car accident), or repetitive (as in a legal secretary who works with his/her hands, wrists, and arms at a fast paced desk station with non-ergonomic posture for many years).
TOS is also found in certain occupations involving lots of lifting of the arms and repetitive use of the wrists and arms.
The two groups of people most likely to develop TOS are those suffering from neck injuries due to traffic accidents and those who use computers in non-ergonomic postures for extended periods of time.
TOS is frequently a repetitive stress injury (RSI) caused by certain types of work environments.
Other groups which may develop TOS are athletes who frequently raise their arms above the head (such as swimmers, volleyball players, shuttlecock players, baseball pitchers, and weightlifters), rock climbers, electricians who work long hours with their hands above their heads, and some musicians.
Scalenus anticus syndrome (compression on brachial plexus and/or subclavian artery caused by muscle growth) – diagnosed by using Adson's sign with patient's head turned outward.
Cervical rib syndrome (compression on brachial plexus and/or subclavian artery caused by bone growth) – diagnosed by using Adson's sign with patient's head turned inward.
Costoclavicular syndrome (narrowing between the clavicle and the first rib) – diagnosed with the costoclavicular maneuver.
Some people are born with an extra incomplete and very small rib above their first rib, which protrudes out into the superior thoracic outlet space.
This rudimentary rib causes fibrous changes around the brachial plexus nerves, inducing compression and causing the symptoms and signs of TOS.
This is called a "cervical rib" because of its attachment to C-7 (the 7th cervical vertebra), and its surgical removal is almost always recommended.
The symptoms of TOS can first appear in the early teen years as a child is becoming more athletic.
TOS affects mainly the upper limbs, with signs and symptoms manifesting in the arms and hands.
Pain is almost always present, and can be sharp, burning, or aching.
It can involve only part of the hand (as in the 4th and 5th finger only), all of the hand, or the inner aspect of the forearm and upper arm.
Pain can also be in the side of the neck, the pectoral area below the clavicle, the axillary area, and the upper back (i.
e.the trapezius and rhomboid area).Decoloration of the hands, one hand colder than the other hand, weakness of the hand and arm muscles, and tingling are commonly present.
TOS is often the underlying cause of refractory upper limb conditions like frozen shoulder and carpal tunnel syndrome that frequently defy standard treatment protocols.
TOS can be related to Cerebrovascular arterial insufficiency when affecting the subclavian artery.
[7] It also can affect the vertebral artery, case in which it could produce transient blindness,[8] and embolic cerebral infarction.
[9] A painful, swollen and blue arm, particularly when occurring after strenuous physical activity, could be a sign of a venous compression or subclavian vein thrombosis called Paget-Schroetter Syndrome.
Adson's sign and the Costoclavicular Maneuver lack specificity and sensitivity, and should comprise only a small part of the mandatory comprehensive history and physical examination undertaken with a patient suspected of having TOS.
There is currently no single clinical sign that makes the diagnosis of TOS with any degree of certainty.
Additional maneuvers that may be abnormal in TOS include the "stick em up hand raise" for up to 3–5 minutes, which involves holding both hands at right angles over the head bent at the elbows, with or without opening and closing of the fingers (a positive test occurs when the affected hand quickly becomes paler than the unaffected because of compromised blood supply), and the "compression test", when exerting pressure between the clavicle and medial humeral head causes radiation of pain and/or numbness into the affected arm.
[10] Doppler Arteriography, with probes at the fingertips and arms, tests the force and "smoothness" of the arterial flow through the radial arteries, with and without having the patient perform various arm maneuvers (which causes compression of the subclavian artery at the thoracic outlet).
The movements can elicit symptoms of pain and numbness and produce graphs with diminished arterial blood flow to the fingertips, providing strong evidence of impingement of the subclavian artery at the thoracic outlet.
[11] Some physicians advocate the injection of a short-acting anesthetic such as xylocaine or marcaine into the anterior scalene, subclavius, or pectoralis minor muscles as a provocative test to assist in the diagnosis of thoracic outlet syndrome.
This is referred to as a 'scalene block' when employing the use of a local anesthetic.
This is not considered a "treatment", however, as the relief is expected to wear off within an hour or two at most.
Active clinical research continues into the specificity, sensitivity, risks and benefits of this provocative test and other types of neuromuscular blocks, particularly at Johns Hopkins Hospital in Baltimore, Maryland (US).
[citation needed].High resolution MRI/MRA of the Brachial Plexus[citation needed].
Most patients respond to conservative measures such as medications, rest, physical therapy, and stretching.
Only a minority of patients with signs and symptoms of TOS ultimately proceed to surgery.
[citation needed].The goal of stretching is to relieve compression in the thoracic cavity, reduce blood vessel and nerve impingement, and realign the bones, muscles, ligaments, and/or tendons that are causing the problem.
One commonly prescribed set of stretches includes moving the shoulders anteriorly (forward - called "hunching"), then back to a neutral position, then extending them posteriorly (backward, called "arching"), then back to neutral, followed by lifting the shoulders up as high as possible, and then back down to neutral - repeated in cycles as tolerated.
Another set of stretches involves tilting and extending the neck opposite to the side of the injury while keeping the injured arm down or wrapped around the back.
Physical therapy can include passive or active range of motion exercises, working up to weighted or restricted sets (as tolerated).
Cases of TOS often involve compression of a large cluster of nerves, typically resulting in motor and/or sensory impairment throughout the arm.
"Nerve gliding exercises" can stretch and mobilize affected nerve fibers and decrease symptomatology and function.
Chronic and intermittent nerve compression has been studied in animal models, and has a well-described pathophysiology, as described by Susan Mackinnon, MDv (currently at Washington University in St.
Louis).[citation needed].Nerve gliding exercises have been studied by several authorities, including David Butler in Australia.
[citation needed].Nerve gliding can be performed by extending the injured arm with fingers directly outwards to the side and tilting the head to both sides.
A gentle pulling feeling is generally felt throughout the injured side.
Initially, only do this and repeat.Once this exercise has been mastered and no extreme pain is felt, begin stretching your fingers back.
Repeat with different variations, tilting your hand up, backwards, or downwards.
TOS is rapidly aggravated by poor posture.Active breathing exercises and ergonomic desk setup and motion practices can help maintain active posture.
Often the muscles in the back become weak due to prolonged (years) of "hunching" and other poor postures.
Ice can be used to decrease inflammation of sore or injured muscles.
Heat can also aid in relieving sore muscles by improving blood circulation to them.
While the whole arm generally feels painful in TOS, some relief can be seen when ice or heat is intermittently applied to the thoracic region (collar bone, armpit, or shoulder blades).
Acupuncture is also an effective method of treatment for TOS.
Patients may feel significantly less pain within 3-4 acupuncture treatment sessions.
[citation needed] Injected into a joint or muscle, cortisone can help lower inflammation and provide relief.
[dubious – discuss] Botox - short for Botulinum Toxin Av - binds nerve endings and prevents the release of neurotransmitters that activate muscles.
A small amount of Botox injected into the tight or spastic muscles (usually one or all three scalenes) found in TOS sufferers often provides months of relief while the muscle is temporarily paralyzed.
This noncosmetic treatment is not covered by most medical insurance plans and costs upwards of $400.
The relief of symptoms from a Botox injection generally lasts 3–4 months, at which point the Botox toxin is degraded by the affected muscles.
Serious side effects have been reported, and are similarly long-lasting, so improved understanding of the mechanism this form of 'scalene block' is vital to determining iks risk-vs.
benefit profile.Additionally, many patients in a study done at Johns Hopkins Hospital in Baltimore report no relief of symptoms from Botox or scalene injections, which may indicate that the pain does not stem from the scalene muscle, and may not be TOS.
Botox can be a effective treatment for neurogenic TOS.[12] It may eliminate pain, or reduce it enough for the victim to undergo physical therapy, and hopefully be able to properly stretch and reduce compression in the affected area.
Surgical Approaches Surgical approaches have also been used successfully in TOS.
[13] In cases where the first rib is compressing a vein, artery, or the nerve bundle, the first rib and scalene muscles and any compressive fibrous tissue can be removed.
This procedure is called a first rib resection and scalenectomy and involves going through the underarm area or back of the neck area and removing the first rib, scalene muscles, and any compressive fibrous tissue to open the area to allow increased blood flow and/or reduce nerve compression.
In some cases there may be a rudimentary rib or a cervical rib that can be causing the compression, which can be removed using the same technique.
Physical therapy is often used before and after the operation to decrease recovery time and improve outcomes.
Potential complications include pneumothorax, infection, loss of sensation, motor problems, and as in all surgeries, a very small risk of permanent serious injury or death.
Major League Baseball players Matt Harrison, Hank Blalock, John Rheinecker, Jeremy Bonderman, Alex Cobb, Kenny Rogers, Jarrod Saltalamacchia, and Noah Lowry[14] have recently been diagnosed with thoracic outlet syndrome.
Kenny Rogers was diagnosed several years earlier with TOS in the other upper extremity (coincidentally, five of these eight players have played for the Texas Rangers).
All-Star pitcher J.R.Richard suffered a career-ending stroke from an undiagnosed case of TOS.
Pitcher David Cone had an unusual "variant" case of TOS, with an arterial aneurysm of the upper aspect of his pitching arm.
Craig Carton of WFAN had Thoracic outlet syndrome and underwent successful microsurgery to cure it.
Athletes who repetitively raise their arms above their heads - such as swimmers, track and field runners, and volleyball players - are known to be predisposed to the development of TOS.
Musician Isaac Hanson suffered a potentially life-threatening pulmonary embolism as a complication of thoracic outlet syndrome.
[15] May-Thurner syndrome - A similar compressive pathology involving the left common iliac vein.
^ Jay Allan Liveson (25 September 2000).Peripheral neurology: case studies.
Oxford University Press US.pp. 255–.ISBN 978-0-19-513563-3.
http://books.google.com/books?id=nARrfwZPVH8C&pg=PA255.
Retrieved 4 August 2010.  ^ Ambrad-Chalela, Esteban; Thomas, George I.; Johansen, Kaj H.
(2004)."Recurrent neurogenic thoracic outlet syndrome".The American Journal of Surgery 187 (4): 505–10.
doi:10.1016/j.amjsurg.2003.12.050.  ^ Selmonosky, M.D., Carlos.
"TOS-Syndrome; Symptoms".http://www.tos-syndrome.com.Retrieved 2011-03-20.
  ^ a b c Fugate, Mark W.; Rotellini-Coltvet, Lisa; Freischlag, Julie A.
(2009)."Current management of thoracic outlet syndrome".Current Treatment Options in Cardiovascular Medicine 11 (2): 176–83.
doi:10.1007/s11936-009-0018-4.PMID 19289030.  ^ Burnand, K.
M.; Lagocki, S.; Lahiri, R.P.; Tang, T.Y.; Patel, A.D.; Clarke, J.
M.F.(2010)."Persistent subclavian artery stenosis following surgical repair of non-union of a fractured clavicle".
Grand Rounds 10: 55–8.doi:10.1102/1470-5206.2010.0012.http://www.grandrounds-e-med.
com/articles/gr100012.pdf.  ^ Thetter, O; Van Dongen, RJ; Barwegen, MG (1985).
"The thoracic outlet compression syndrome and its vascular complications".
Zentralblatt fur Chirurgie 110 (8): 449–56.PMID 4002908.
  ^ Sell, James J.; Rael, Jesse R.; Orrison, William W.(1994)."Rotational vertebrobasilar insufficiency as a component of thoracic outlet syndrome resulting in transient blindness".
Journal of Neurosurgery 81 (4): 617–9.doi:10.3171/jns.1994.81.
4.0617.PMID 7931599.  ^ Nishibe, T; Kunihara, T; Kudo, FA; Adachi, A; Shiiya, N; Murashita, T; Matusi, Y; Yasuda, K (2000).
"Arterial thoracic outlet syndrome with embolic cerebral infarction.
Report of a case".Panminerva medica 42 (4): 295–7.
PMID 11294095.  ^ Christo, Paul J; Dana K Christo; Adam J Carinci; Julie A Freischlag (April 2010).
"Single CT-Guided Chemodenervation of the Anterior Scalene Muscle with Botulinum Toxin for Neurogenic Thoracic Outlet Syndrome".
Pain Medicine 11 (4): 504–511.  ^ Rochkind, S; Shemesh, M; Patish, H; Graif, M; Segev, Y; Salame, K; Shifrin, E; Alon, M (2007).
"Thoracic outlet syndrome: a multidisciplinary problem with a perspective for microsurgical management without rib resection".
Acta neurochirurgica.Supplement 100: 145–7.doi:10.1007/978-3-211-72958-8_31.PMID 17985565.
  ^ "People Magazine".Archived from the original on October 18, 2007.
http://web.archive.org/web/20071018005700/http://www.hanson.net/site/hanson/blog_entry/1?
entry_id=5832.Retrieved 2008-01-01.  Society for Vascular Surgery (U.
S.) This page was last modified on 7 May 2012 at 22:29.Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply.
See Terms of use for details.Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc.
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Stay up to date on the latest health information.Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet — the space between your collarbone and your first rib — become compressed.
This can cause pain in your shoulders and neck and numbness in your fingers.
Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects, such as having an extra rib, and pregnancy.
Even a long-ago injury can lead to thoracic outlet syndrome in the present.
Sometimes doctors can't determine the cause of thoracic outlet syndrome.
Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures.
Most people improve with these conservative approaches.
In some cases, however, your doctor may recommend surgery.Sheon RP.Overview of the nerve entrapment syndromes.
http://www.uptodate.com/home/index.html.Accessed Sept.
  • Charles B Webster Detention Center 1941 Phinizy Road Augusta 30906 (706) 821-1101
7, 2010.NINDS thoracic outlet syndrome information page.National Institute of Neurological Disorders and Stroke.
http://www.ninds.nih.gov/disorders/thoracic/thoracic.
htm.Accessed Sept.4, 2010.Thoracic outlet syndrome.American Academy of Orthopaedic Surgeons.
http://orthoinfo.aaos.org/topic.cfm?topic=a00336.Accessed Sept.
4, 2010.Thoracic outlet syndrome.National Pain Foundation.http://www.
nationalpainfoundation.org/articles/577/what-is-it?Accessed Sept.
4, 2010.Thoracic outlet compression syndromes.The Merck Manuals: The Merck Manual for Healthcare Professionals.
http://www.merck.com/mmpe/sec16/ch223/ch223k.html?qt=thoracic%20outlet%20syndrome&alt=sh.
Accessed Sept.4, 2010.Thoracic outlet syndrome.Society for Vascular Surgery.
http://www.vascularweb.org/vascularhealth/Pages/ThoracicOutletSyndrome.aspx.Accessed Sept.
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Thoracic Outlet Syndrome (TOS) Causes, Treatment, Symptoms and Diagnosis on MedicineNet.
com A reddish, scaly rash often located over the surfaces of the elbows, knees, scalp, and around or in the ears, navel, genitals or buttocks...
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Take the Sex & Love Quiz!The brain.The body.The bedroom.What do you know?William C.
Shiel Jr., MD, FACP, FACR William C.Shiel Jr., MD, FACP, FACR Dr.Shiel received a Bachelor of Science degree with honors from the University of Notre Dame.
There he was involved in research in radiation biology and received the Huisking Scholarship.
After graduating from St.Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine.
He is board-certified in Internal Medicine and Rheumatology.What is thoracic outlet syndrome?
What are symptoms of thoracic outlet syndrome?How is thoracic outlet syndrome diagnosed?
What is the treatment for thoracic outlet syndrome?It took three years and three months, three MRI's, two x-rays, two EMG's, and nine health-care professionals for me to feel better.
It was a journey that felt like forever with exhausting highs and lows.
Each new doctor's appointment was entered into with hope and walked out of in despair.
Those who were unable to diagnose my condition were able to make me think that it was all in my head.
Fortunately, or unfortunately, my symptoms progressed and out of desperation I gave one last doctor a chance.
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That last chance saved my sanity and gave me back my life.My symptoms started off somewhat vague.I had taken on a new position at work that required a lot of time on the computer.I began having pain on my right side in my neck and shoulder with tingling in my hand at the end of the day.I felt a lump on my cervical spine that I assumed to be the cause of the symptoms.I went to an orthopedic surgeon who sent me for an MRI to rule out a tumor.I was assured that he had never seen a tumor in that area, but that did not ease the heart-wrenching fear of a possible tumor.

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