“…Diagnosis of TOS is challenging; there is no single physical exam finding, test, or modality to diagnose TOS with certainty. Although cases exist with definitive findings that demonstrate lower trunk neurologic injury due to cervical bands, many cases lack such findings 25 . Some authors have even used the term “disputed” TOS, given that many patients present with a constellation of symptoms similar to TOS but lack definitive findings 8 .…”
Section: Discussionmentioning
confidence: 99%
“…Although cases exist with definitive findings that demonstrate lower trunk neurologic injury due to cervical bands, many cases lack such findings. 25 Some authors have even used the term "disputed" TOS, given that many patients present with a constellation of symptoms similar to TOS but lack definitive findings. 8 TOS requires a clinical diagnosis with a combination of symptoms, positive examination findings or stress maneuvers, and additional ancillary tests or imaging modalities.…”
Botulinum toxin (BTX) injections into the musculature surrounding the brachial plexus have been examined as a potential treatment for neurogenic thoracic outlet syndrome (nTOS). This systematic review identified 15 publications, of which one was a randomized controlled trial. BTX injections performed with ultrasound or electromyographic guidance, and with the inclusion of the pectoralis minor muscle, in addition to the anterior and/or middle scalenes, tended to provide greater symptom improvement and may predict response to first rib resection. Importantly, most studies were of low quality; thus, the results should be interpreted with caution. Further high‐quality studies are needed to confirm these findings.
“…Diagnosis of TOS is challenging; there is no single physical exam finding, test, or modality to diagnose TOS with certainty. Although cases exist with definitive findings that demonstrate lower trunk neurologic injury due to cervical bands, many cases lack such findings 25 . Some authors have even used the term “disputed” TOS, given that many patients present with a constellation of symptoms similar to TOS but lack definitive findings 8 .…”
Section: Discussionmentioning
confidence: 99%
“…Although cases exist with definitive findings that demonstrate lower trunk neurologic injury due to cervical bands, many cases lack such findings. 25 Some authors have even used the term "disputed" TOS, given that many patients present with a constellation of symptoms similar to TOS but lack definitive findings. 8 TOS requires a clinical diagnosis with a combination of symptoms, positive examination findings or stress maneuvers, and additional ancillary tests or imaging modalities.…”
Botulinum toxin (BTX) injections into the musculature surrounding the brachial plexus have been examined as a potential treatment for neurogenic thoracic outlet syndrome (nTOS). This systematic review identified 15 publications, of which one was a randomized controlled trial. BTX injections performed with ultrasound or electromyographic guidance, and with the inclusion of the pectoralis minor muscle, in addition to the anterior and/or middle scalenes, tended to provide greater symptom improvement and may predict response to first rib resection. Importantly, most studies were of low quality; thus, the results should be interpreted with caution. Further high‐quality studies are needed to confirm these findings.
“…33 A Gilliatt-Sumner hand refers to atrophy of the abductor pollicis brevis, and possibly the abductor digiti minimi and/or first dorsal interosseous, but with preservation of sensation in the distribution of the median nerve. 46 A positive Tinel sign about the interscalene triangle or supraclavicular region may be present. 34 Compression over the supraclavicular region (also known as supraclavicular pressure test or Morley test) may reproduce pain and paresthesias.…”
Section: Symptoms and Evaluationmentioning
confidence: 99%
“…The practitioner should look for evidence of temperature/color changes, swelling, or atrophy 33 . A Gilliatt–Sumner hand refers to atrophy of the abductor pollicis brevis, and possibly the abductor digiti minimi and/or first dorsal interosseous, but with preservation of sensation in the distribution of the median nerve 46 . A positive Tinel sign about the interscalene triangle or supraclavicular region may be present 34 .…”
Peripheral nerve injuries in athletes affect the upper limb more commonly than the lower limb. Common mechanisms include compression, traction, laceration, and ischemia. Specific sports can have unique mechanisms of injury and are more likely to be associated with certain neuropathies. Familiarity with these sport‐specific variables and recognition of the common presentations of upper limb neuropathic syndromes are important in assessing an athlete with a suspected peripheral nerve injury. Evaluation may require imaging modalities and/or electrodiagnostic testing to confirm a nerve injury. In some cases, diagnostic injections may be needed to differentiate neuropathic versus musculoskeletal etiology. Early and accurate diagnosis is essential for treatment/management and increases the likelihood of a safe return‐to‐sport and avoidance of long‐term functional consequences. Most nerve injuries can be treated conservatively, however, severe or persistent cases may require surgical intervention. This monograph reviews key diagnostic, management, and preventative strategies for sports‐related peripheral nerve injuries involving the upper limb.
“…Thus, they are the most likely neural elements to be compromised by variations within the scalene triangle (ie, accessory scalenes, enlarged transverse processes, fibrotic bands, suspensory pleural dome ligaments, and others). 31 , 32 , 33 Figure 2 Inlet and outlet renderings illustrating anatomic relationships of the neurovascular bundle and osseous structures. A Inlet view with subtraction of the brachial plexus, demonstrating the proximity of the subclavian vessels between the clavicle and first rib.…”
Section: Thoracic Outlet Anatomy and Biomechanicsmentioning
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