Choosing Surgery for Neurogenic TOS: The Roles of Physical Exam, Physical Therapy, and Imaging

Kuwayama, David P.; Lund, Jason R.; Brantigan, Charles O.; Glebova, Natalia O.

doi:10.3390/diagnostics7020037

Cited by 22 publications

(20 citation statements)

References 37 publications

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“…Neurogenic thoracic outlet syndrome remains a difficult diagnosis, given its rarity, limitations of the physical exam and potential equivocal findings on imaging . In this patient, neuromuscular ultrasound was informative as it demonstrated the cervical rib adjacent to and constricting the trunks of the brachial plexus.…”

Section: Representative Casementioning

confidence: 87%

“…A history and physical examination is always the first step in a comprehensive evaluation of suspected brachial plexus pathology. 2 Electrodiagnostic testing aids in localization and diagnosis, but can be confounded by other factors. This includes temporal changes after an acute injury, patchy involvement of the brachial plexus and comorbid factors such as underlying generalized neuropathy or cervical radiculopathy.…”

Section: Accepted 12 April 2018mentioning

confidence: 99%

“…These lesions are often anatomically complex and, therefore, present diagnostic challenges. A history and physical examination is always the first step in a comprehensive evaluation of suspected brachial plexus pathology . Electrodiagnostic testing aids in localization and diagnosis, but can be confounded by other factors.…”

mentioning

confidence: 99%

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Neuromuscular ultrasound of the brachial plexus: A standardized approach

et al. 2018

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Reliable assessment of brachial plexus disorders can be challenging due to the complexity of the anatomy and variation of potential pathology. Electrodiagnostic testing can be both uncomfortable for the patient and inconclusive. Ultrasound can serve as a complement to clinical assessment, electrodiagnostic testing, and other imaging modalities. This study describes a systematic approach for performing neuromuscular ultrasound for suspected pathology in the brachial plexus. The literature regarding techniques for brachial plexus ultrasound was reviewed. A team composed of specialists in neurology, physiatry, anesthesiology, orthopedic surgery, and vascular surgery used this as the basis for describing standardized techniques for performing brachial plexus ultrasound. Four standard views, along with other supplemental views, are described for the evaluation of the brachial plexus. An illustrative case is presented. Ultrasound is a high-resolution point of care diagnostic tool that allows assessment of structural pathology affecting the brachial plexus. Muscle Nerve 58: 618-624, 2018.

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Section: Representative Casementioning

confidence: 87%

Section: Accepted 12 April 2018mentioning

confidence: 99%

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Neuromuscular ultrasound of the brachial plexus: A standardized approach

et al. 2018

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“…Here, CT, chest radiography, and cervical spine films may show the presence of a cervical rib or elongated C7 transverse process. MRI on the other hand can evaluate soft tissue structures that might contribute to compression, such as fibrous bands, and can exclude cervical root compression as a differential diagnosis [ 28 ].…”

Section: Investigationsmentioning

confidence: 99%

Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions

Povlsen

2018

Diagnostics

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The diagnosis of thoracic outlet syndrome (TOS) has long been a controversial and challenging one. Despite common presentations with pain in the neck and upper extremity, there are a host of presenting patterns that can vary within and between the subdivisions of neurogenic, venous, and arterial TOS. Furthermore, there is a plethora of differential diagnoses, from peripheral compressive neuropathies, to intrinsic shoulder pathologies, to pathologies at the cervical spine. Depending on the subdivision of TOS suspected, diagnostic investigations are currently of varying importance, necessitating high dependence on good history taking and clinical examination. Investigations may add weight to a diagnosis suspected on clinical grounds and suggest an optimal management strategy, but in this changing field new developments may alter the role that diagnostic investigations play. In this article, we set out to summarise the diagnostic approach in cases of suspected TOS, including the importance of history taking, clinical examination, and the role of investigations at present, and highlight the developments in this field with respect to all subtypes. In the future, we hope that novel diagnostics may be able to stratify patients according to the exact compressive mechanism and thereby suggest more specific treatments and interventions.

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“…[ 1 ] Neurogenic TOS is the most common manifestation of this disorder and is characterized by arm and hand pain, paresthesias, and weakness resulting from compression of the brachial plexus within the thoracic outlet. [ 2 ] There are many patients who do not show symptoms and therefore remain undiagnosed, yet may present for nonrelated procedures. Clinicians must be cognizant of TOS manifesting during the perioperative period when there are acute changes such as sudden loss of arterial pressure waveforms, contralateral upper extremity swelling, and ischemic changes of the ipsilateral side that may potentially be provoked by prone positioning and head rotation away from the affected side.…”

mentioning

confidence: 99%