A Thoracic Outlet Syndrome That Concealed a Glioblastoma. Findings from a Case Report

Storari, Lorenzo; Signorini, M.; Barbari, Valerio; Mourad, Firas; Bisconti, Mattia; Salomon, Mattia; Rossettini, Giacomo; Maselli, Filippo

doi:10.3390/medicina57090908

Cited by 2 publications

(1 citation statement)

References 57 publications

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“…As an increasing number of countries have physiotherapists acting as entry level providers or assuming first contact roles, there is an increasing need for triage and differential diagnosis skills [ 52 , 53 , 54 ]. According to a previous review of the literature [ 55 ], the management accuracy of the physiotherapist working in a direct access setting was confirmed by the percentage of patients evaluated independently [ 16 , 18 , 19 , 26 , 31 , 36 , 40 , 41 , 42 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review

Gallotti,

Campagnola,

Cocchieri

et al. 2023

JCM

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Background. Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in musculoskeletal diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that requires physician referral to access physiotherapist services. This traditional physician referral often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries. Objectives. The primary objective of this systematic review was to compare the effectiveness, safety, and the accuracy of DAPT compared to the physician-led model of care for the management of patients with musculoskeletal disorders. The secondary objective of the present study is to define the physiotherapists’ characteristics or qualifications involved in DAPT. Materials and methods. Databases searched included: Medline, Scopus and Web of Science. Databases were searched from their inception to July 2022. Research strings were developed according to the PICO model of clinical questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators (AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-of-bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Authors conducted a qualitative analysis of the results through narrative analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key concepts and common meanings of the different studies, while the summary narrative provided a textual combination of data. In addition, a quantitative analysis was conducted comparing the analysis of the mean and differences between the means. Results. Twenty-eight articles met the inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs, and referral to another specialist. DAPT was found to be more cost-effective than the medical model. DAPT resulted in better work-related outcomes and was superior when considering patient satisfaction. There were no adverse events noted in any of the studies. In regard to health outcomes, there was no difference between models. ROB-2 shows an intermediate risk of bias risk for the RCTs with an average of 6/9 points for the NOS scale for observational studies. Conclusion. DAPT is a safe, less expensive, reliable triage and management model of care that results in higher levels of satisfaction for patients compared to the traditional medical model. Prospero Registration Number: CRD42022349261.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review

Gallotti,

Campagnola,

Cocchieri

et al. 2023

JCM

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Thoracic outlet syndrome caused by superior mediastinal mass: A case report

Kakamad,

Asaad,

Tahir

et al. 2024

Asian Cardiovasc Thorac Ann

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Introduction Thoracic outlet syndrome (TOS) caused by superior mediastinal soft tissue mass has never been reported in the literature, the aim of this study is to discuss a case of TOS caused by a superior mediastinal mass in which the histopathological examinations of the mass showed vascular malformation. Case report A 45-year-old female presented with left upper limb pain and numbness for three months, associated with swelling and attacks of shortness of breath. Imaging studies showed soft tissue mass involving the superior mediastinum. The condition of the patient deteriorated and the signs and symptoms of TOS became clearer, all provocative tests and nerve conduction studies were positive. The patient underwent thoracic outlet decompression. The patient did not respond and the symptoms deteriorated further. After a multidisciplinary board discussion, the patient was prepared for median sternotomy under general anesthesia. A total resection of the mass was done. The patient was totally relieved a few hours after the operation. Discussion The etiology of TOS can be multifaceted. Several factors contribute to its onset, and these can be categorized as congenital or acquired. Congenital causes include anatomical anomalies such as a cervical rib, or an elongated transverse process of the cervical vertebrae. These anatomical deviations can reduce the size of the thoracic outlet and make it prone to compression. Conclusion Although it is rare, TOS could be due to superior mediastinal mass and the treatment of choice is total resection either through median sternotomy or thoracoscopic procedure.

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A Thoracic Outlet Syndrome That Concealed a Glioblastoma. Findings from a Case Report

Cited by 2 publications

References 57 publications

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review

Thoracic outlet syndrome caused by superior mediastinal mass: A case report

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