Symptoms Of Thoracic Outlet Syndrome Research Articles

Brachial Artery Entrapment: Compression by the Supracondylar Process

Ischemia occurring during hyperextension of the upper limb in a 25-year-old woman led to the discovery of a supracondylar spur responsible for compression of the brachial artery with anomalous insertion of the pronator teres muscle. Resection of all abnormal structures provided immediate relief of symptoms. When atypical arterial symptoms of thoracic outlet syndrome occur in the upper limb, the brachial artery entrapment syndrome should be considered.

Headache as the leading symptom of the thoracic outlet syndrome.

SYNOPSISIntractable headache is a common presenting symptom of the thoracic outlet syndrome (TOS). We followed thirty patients for at least six months after transaxillary first rib resection. Prior to surgery, twenty‐six reported recurring headache before the appearance of neck and shoulder pain; headache was lateralized in 21 and continual in 14. In 11, intensification of TOS symptoms accompanied headache. After surgery, 11 previously disabled patients returned to work; 13 became head‐ache‐free. Eleven others reported benefit from vaso‐active drugs that had been ineffective pre‐operatively.

Subclavicular approach to first rib resection

As discussed by Urschel [13], 50 to 70 percent of patients with symptoms of thoracic outlet syndrome may be treated conservatively by nonsurgical methods. Patients who still have symptoms after years of such therapy are referred to us for surgical treatment. Failure to obtain symptomatic relief after scalenotomy alone [8] caused us to abandon this treatment. The advantages of the subclavicular approach to first rib resection are as follows: (1) The operation is easy and fast. (2) There is good visibility in the operative field. (3) The neurovascular bundle to the arm lies cephalad and out of harm's way. (4) The complication (infection) rate is very low. (5) The operation allows adequate resection of the first rib. (6) The operation allows the addition of upper extremity sympathectomy. The disadvantage is the position of the scar in a young woman, although lateral placement of the scar does not seem to cause much emotional trauma.

Congenital anomalies associated with thoracic outlet syndrome: Anatomy, symptoms, diagnosis, and treatment

Personal evaluation of more than 2,300 patients for possible thoracic outlet syndrome (TOS) and knowledge gained from 980 TOS operations in 766 patients (operative incidence of 33.7 per cent of the patients examined) have shown that most patients with TOS have anomalous fibrous muscular bands near the brachial plexus that predispose them to neurologic irritation or compression involving the plexus. Anatomic analysis during operations for TOS, plus cadaver dissections, have disclosed seven distinct types of fibromuscular bands in addition to the less frequent bony anomalies long associated with neurovascular compression. One third of fifty-eight cadaver thoracic outlets dissected showed at least one of the seven muscular anomalies recognized at operations. These anomalies can be accurately related to the patients' symptoms, which are neurologic complaints in 99 per cent of the patients examined who ultimately have the diagnosis of TOS established. Neurologic symptoms are clearly explained by the anomalous bands irritating or compressing the brachial plexus and rarely have any effect on the subclavian vessels. These studies, and others before, have shown no correlation with impairment of circulation or positional radial pulse changes in almost all patients with true TOS. Also, arteriograms and nerve conduction studies generally have failed to be of value in establishing the accurate diagnosis. Reasons for these conclusions are explained, and the most reliable tests are described. The most effective means of relief of severe symptoms of TOS is to alter the mechanical irritation or compression of the brachial plexus by completely resecting the first thoracic rib and all anomalous fibromuscular tissue around the plexus and subclavian vessels. If patients are thoroughly evaluated with appropriate tests and highly selected for surgical treatment, gratifying relief will result in more than 90 per cent of patients, if the correct operation is performed with meticulous technic.