Abstract
Neurogenic thoracic outlet syndrome (nTOS) is a musculoskeletal disorder in which compression of the brachial plexus between the scalene muscles of the neck and the first rib results in disabling upper extremity pain and paresthesia. Currently there are no objective metrics for assessing the disability of nTOS or for monitoring response to its therapy. We aimed to develop digital biomarkers of upper extremity motor capacity that could objectively measure the disability of nTOS using an upper arm inertial sensor and a 20-s upper extremity task that provokes nTOS symptoms. We found that digital biomarkers of slowness, power, and rigidity statistically differentiated the affected extremities of patients with nTOS from their contralateral extremities (n = 16) and from the extremities of healthy controls (n = 13); speed and power had the highest effect sizes. Digital biomarkers representing slowness, power, and rigidity correlated with patient-reported outcomes collected with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the visual analog scale of pain (VAS); speed had the highest correlation. Digital biomarkers of exhaustion correlated with failure of physical therapy in treating nTOS; and digital biomarkers of slowness, power, and exhaustion correlated with favorable response to nTOS surgery. In conclusion, sensor-derived digital biomarkers can objectively assess the impairment of motor capacity resultant from nTOS, and correlate with patient-reported symptoms and response to therapy.
Highlights
Neurogenic thoracic outlet syndrome is a musculoskeletal disorder in which the brachial plexus is dynamically compressed within the scalene triangle, an anatomic space bordered by the anterior and middle scalene muscles where they insert on the first rib
No statistical significance between Neurogenic thoracic outlet syndrome (nTOS) and control participants was observed for age, height, and hand dominance; the nTOS group participants were enriched for females and for individuals with higher body mass index (BMI)
To explore whether digital biomarkers of upper extremity motor capacity could have a clinical advantage over patient-reported measures, we investigated their association with work disability
Summary
Neurogenic thoracic outlet syndrome (nTOS) is a musculoskeletal disorder in which the brachial plexus is dynamically compressed within the scalene triangle, an anatomic space bordered by the anterior and middle scalene muscles where they insert on the first rib. Brachial plexus compression results in upper extremity pain and paresthesia that are exacerbated by the organic narrowing of the scalene triangle that occurs with hand-over-head activity. There are no standardized methods for assessing the severity of nTOS or for assessing the efficacy of any therapy for nTOS. This has resulted in highly variable nTOS treatment protocols and has perpetuated confusion among patients and providers on assignment of best therapy. The lack of reliable metrics for assessing the severity of nTOS has precluded the rigorous assessment of nTOS therapy, limited confidence in available therapies, and constrained the design and conduct of the clinical trials that are needed to advance the field
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
