The diagnosis of thoracic outlet syndrome
It is often difficult to demonstrate that a confirmed neurovascular compression at the thoracic outlet is also the cause of the patient’s complaints. A careful clinical examination must therefore be completed by objective tests to define the exact site and mechanism of compression. Such objective tests are also valuable and necessary to evaluate surgical results. The phonoangiogram is one of these simple, painless, objective and reproducible tests.
Arterial compression occurs frequently in extreme positions of the arm even in normal subjects. If, in a symptomatic patient, signs of compression are present on simple abduction, functional angiography is indicated.
Similarly, venous obstruction in extreme positions of the arm can be demonstrated by pressure measurements and phlebograms on many healthy symptom-free individuals. These two tests are nevertheless useful in the detection of intermittent, functional compression mechanisms.
A majority of the patients present neurologic symptoms. The diagnosis of TOS, especially the differentiation of normal versus pathological findings in a patient with essentially neurologic symptoms, is not easy.
Only thorough evaluation of the patient, careful clinical examination combined with objective vascular (and therefore indirect) tests, will help to make the diagnosis accurate.
KeywordsCarpal Tunnel Syndrome Subclavian Artery Nerve Conduction Velocity Extreme Position Shoulder Girdle
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