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Thoracic outlet syndrome (TOS) is a condition in which there is compression of the nerves, arteries, or veins in the superior thoracic aperture, the passageway from the lower neck to the armpit, also known as the thoracic outlet. [1] There are three main types: neurogenic, venous, and arterial. [1]
Thrombolysis is typically performed prior to first rib resection for venous thoracic outlet syndrome. First rib resection is indicated for venous , arterial , and neurogenic TOS. [ 1 ] In all cases, the goal of the operation is to increase the dynamic space between the chest wall and the clavicle , through which the subclavian vein, artery, and ...
The superior thoracic aperture is essentially a hole surrounded by a bony ring, through which several vital structures pass. It is bounded by: the first thoracic vertebra (T1) posteriorly; the first pair of ribs laterally, forming lateral C-shaped curves posterior to anterior; and the costal cartilage of the first rib and the superior border of the manubrium anteriorly.
The excess pressure of thoracic outlet syndrome may be reduced by rib removal. [1] Major surgery to the thoracic cavity, such as open heart surgery , may require removal of ribs to allow access to the organ being operated on.
Pectoralis minor syndrome (PMS) is a condition related to thoracic outlet syndrome (TOS) that results from the pectoralis minor muscle being too tight. [1] PMS results from the brachial plexus being compressed under the pectoralis minor [2] while TOS involves compression of the bundle above the clavicle. In most patients, the nerves are ...
Various imaging techniques can also be used to show nerve compression such as x-ray for the wrist, and MRI for the thoracic outlet and cervico-brachial areas. Utilization of routine imaging is useful in early detection and treatment of overuse injuries in at risk populations, which is important in preventing long term adverse effects.
A positive Pemberton's sign is indicative of superior vena cava syndrome (SVC), commonly the result of a mass in the mediastinum.Although the sign is most commonly described in patients with substernal goiters where the goiter "corks off" the thoracic inlet, [4] the maneuver is potentially useful in any patient with adenopathy, tumor, or fibrosis involving the mediastinum.
thoracic outlet syndrome Wright's test is a clinical sign in which the radial pulse weakens or disappears when the arm is abducted and externally rotated . [ 1 ] [ 2 ] It occurs in some patients with thoracic outlet syndrome .