Shoulder Isokinetic Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome

Abstract

Neurogenic thoracic outlet syndrome (NTOS) is an impairing painful condition. Patients usually report upper-limb pain, weakness and paresthesia. Shoulder weakness is frequently reported but has never been described with objective strength evaluation. We aimed to compare isokinetic shoulder strength between patients with NTOS and healthy controls. Patients and controls were prospectively evaluated with an isokinetic strength test at 60 and 180°/s, and an endurance test (30 repetitions at 180°/s) of the shoulder rotators. Patients were functionally assessed with QuickDASH questionnaires. One hundred patients and one hundred healthy subjects were included. Seventy-one percent of patients with NTOS were females with a mean age of 39.4 ± 9.6. They were compared to controls, 73% females and the mean age of 38.8 ± 9.8. Patients’ mean QuickDASH was 58.3 ± 13.9. Concerning the peak of strength at 60°/s, the symptomatic limbs of patients with NTOS had significantly 21% and 29% less strength than the control limbs for medial and lateral rotators, respectively (p ≤ 0.001). At 180°/s, the symptomatic limbs had significantly 23% and 20% less strength than the controls for medial and lateral rotators, respectively (p ≤ 0.001). The symptomatic limbs had significantly 45% and 30% less endurance than the controls for medial and lateral rotators, respectively (p ≤ 0.001). These deficits were correlated to the QuickDASH. Patients with NTOS presented a significant deficit of strength and endurance of the shoulder rotators correlated to disability. This highlights the interest in upper-limb strength evaluation in the diagnostic process and the follow-up of NTOS.

Use of hand hydraulic dynamometers as an overall evaluation of the upper-limb weakness in patients with thoracic outlet syndrome

“…As previously published, we confirmed a grip strength deficit on the symptomatic hand of about 12% compared to the asymptomatic side (18). We also found a deficit of strength on the key pinch and on the shoulder rotators on the symptomatic upper-limbs, whereas this was not the case in previous works which had found only significant decreases of strength compared to controls but no significant differences between symptomatic and asymptomatic sides, excepted concerning lateral rotators endurance (18,19). The differences in the current study may be due to the greater number of included subjects from +30 to +53%, which can account for a stronger statistical power.…”

“…Likewise, Daley et al (19) also showed a severe isokinetic strength deficit of the medial and lateral shoulder rotators. Thereby, these two studies highlighted the interest of proximal and distal upper-limb strength measurement in the evaluation of NTOS (18,19). In fact, hydraulic hand dynamometers and pinch gauges can reliably assess strength at the hand level (20-22), and isokinetic shoulder testing can provide accurate and reliable evaluations to measure shoulder strength, especially for medial and lateral rotator muscles (23)(24)(25).…”

Thoracic Outlet Syndrome in Sport: A Systematic Review

“…V-TOS can be suspected in case of arm swelling with discoloration and heaviness, and abnormal visibility of the chest venous collaterals ( Illig et al, 2016 ). N-TOS diagnosis is more difficult with multiple symptoms, usually including pain, arm weakness, and strength deficit ( Fouasson-Chailloux et al, 2021a ; Daley et al, 2021 ), but the CORE-TOS study group has proposed diagnostic criteria in 2013 and 2016, such as symptoms present for at least 12 weeks, extending beyond the distribution of a single cervical nerve root or peripheral nerve and, that had not been satisfactorily explained by another condition and met at least one criterion in at least four of five specific categories ( Thompson et al, 2013 ; Thompson, 2021 ). In these criteria, only two provocative maneuvers have been retained: the upper limb tension test (ULTT) and the 3-min elevated arm stress test (EAST).…”

Use of Electroneuromyography in the Diagnosis of Neurogenic Thoracic Outlet Syndrome: A Systematic Review and Meta-Analysis

“…The description of “Gilliatt-Sumner-hand” in 1970, associating a cervical rib with hypothenar or thenar atrophy, is currently considered one of the many features of thoracic outlet syndrome [ 8 , 15 , 27 ]. This finding is scarce in wide cohorts of NTOS patients, even though weakness and decreased endurance have been described [ 5 , 6 ]. Most patients display only subjective symptoms linked to intermittent compression, and have no clinical deficit on examination [ 8 , 9 ].…”

“…Neurogenic TOS (NTOS) represents approximately 90% of patients with thoracic outlet syndrome [ 1 , 3 , 4 ]. It is an impairing and painful condition, responsible for a lack of force and endurance, both at the proximal and distal upper-limb level [ 5 , 6 , 7 ]. NTOS diagnosis remains challenging because it is based on the exclusion of other diagnoses, and on symptoms and clinical examination [ 2 , 8 , 9 , 10 ].…”