Abstract
Objectives: Thoracic outlet syndrome (TOS) is an upper extremity disorder resulting from compression of brachial plexus structures and subclavian vessels within thoracic outlet region at any of the three primary sites- interscalene triangle, costoclavicular space and retro-pectoralis minor space. This study focused on detailed anatomic exploration and measurement of normal anatomic variability within interscalene triangle and costoclavicular space. Material and Method: We examined 49 cadavers (22 male and 27 female) and dissected both sides to explore and examine 98 dissected areas. We measured the base width, height, angle within interscalene triangle and the vertical distance within costoclavicular space. We also calculated the area of interscalene triangle. Results: The mean values of base width, height, interscalene angulation of interscalene triangle and height of costoclavular space was 10.18±4.31 mm, 45.19±0.07mm, 10.85±0.06 degrees and 10.22±0.07 mm respectively. The mean area of interscalene triangle was 214.82±5.22sqmm. Conclusion: We have found clinically significant differences between the interscalene and costiclavicular space vertical heights; the height of costoclavicular space was clinically significantly lower than the interscalene space (p< 0.001). No clinical significant difference was found between male and female measurements. These ranges of dataset could be useful for planning treatment approaches in TOS.
Highlights
Thoracic outlet syndrome (TOS) characteristically develops from abnormalities or changes that produce constriction at one or combination of three specific anatomical locations: interscalene triangle, costoclavicular space and coracopectoral tunnel. (Hooper et al, 2010; Atasoy, 1996; Demondion et al, 2006; Jordan et al., 2013)
We focused on measurements of the height, width, angle and area of inter scalene triangle and height of costoclavicular space, compare the values of interscalene triangle and costo-clavicular spaces in male and female cadavers to understand the difference and get the range of values in thoracic outlet compression areas
The lower (C8–T1) trunk crossed the inferior part of the interscalene triangle posterior to the subclavian artery
Summary
Thoracic outlet syndrome (TOS) characteristically develops from abnormalities or changes that produce constriction at one or combination of three specific anatomical locations: interscalene triangle, costoclavicular space and coracopectoral tunnel. (Hooper et al, 2010; Atasoy, 1996; Demondion et al, 2006; Jordan et al., 2013). Thoracic outlet syndrome (TOS) characteristically develops from abnormalities or changes that produce constriction at one or combination of three specific anatomical locations: interscalene triangle, costoclavicular space and coracopectoral tunnel. Dahlstrom and Olinger, 2012).The anterior rami of the third, fourth, and fifth cervical spinal nerves and the superior, middle and inferior trunks of the brachial plexus and subclavian artery are located within the interscalene triangle. As subclavian vessels and brachial plexus traverse into the upper limb, potential exists for compression at this site. According to magnetic resonance imaging and computed tomographic studies, of the three potential locations for TOS related compression, the costoclavicular space is the most susceptible.
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