Summary
The authors present 280 patients operated on for thoracic outlet syndrome (TOS). In a first group of patients anatomical variants were the striking findings. The underlying factor for TOS development is therefore a well defined structural condition and its pathogenetic mechanism is known to be a nerve fibre compression.
In a second group there was no specific salient finding but a postural deviation. The unique pathological features were adhesions of the brachial plexus to the scalenus muscle. Consequently its pathogenetic mechanism is generally recognized as nerve fibre distraction.
In all patients neurological, vascular and myofascial pain symptoms were observed before the operation. Neurological and vascular pain disappeared after surgery, while the myofascial pain remained.
The authors believe that especially in the second, larger group of patients enhancement of the pain-immobility-fibrosis loop is the central pathogenetic factor on which surgical therapy is successful, and that myofascial hemisyndrome — probably arising from a long-standing postural deviation — is not a TOS dependent symptom. In TOS, therefore, there is a pain loop that cannot be resolved by surgical therapy alone.
The connection between myofascial pain syndrome and TOS might explain the many controversial opinions regarding frequency, results and surgical possibilities of this lesion.
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References
Bengtsson A, Henriksson KG (1986) Primary fibromyalgia: a clinical and laboratory study of 55 patients. Scand J Rheumatol 15: 340–347
Bengsstrom A, Henriksson KG, Latsson J (1986) Muscle biopsy in primary fibromyalgia: light microscopical and histochemical findings. Scand J Rheum 15: 1
Boissevan DM, Glenn McCain (1991) Toward an integrated understanding of fibromyalgia syndrome. Medical and Pathophysiological aspects 45: 227–238
Boissevan DM, Glenn McCain (1991) Toward an integrated understanding of fibromyalgia syndrome. Psychological and phenomenological aspects. Pain 45: 239–248
Crotti FM (2002) Sindrome dell’egresso toracico. In: Papo I, Villani R et al (eds) Neurochirurgia Clinica. CG Edizioni Medico Scientifiche, Torino, pp 600–614
Crotti FM, Baiguini PM, Rampini E, Corona C (1998) Conflitto neuro-vascolare a carico di nervi periferici somatici. First World postgraduate surgical week of the University of Milan, Milan
Elvey R (1979) Brachial plexus tension tests and the pathoana-tomical origin of arm pain. Proceedings, aspects of manipulative therapy. Lincoln Institute of Health Sciences, Melbourne, pp 105–110
Gower WR (1904) Lumbago, its lesson or analogues. Br Med J 1: 117–121
Henck PK (1977) Nonarticular rheumatism. In: WA Katz (ed) Rheumatic diseases, diagnosis and management. Lippincott, Philadelphia
Judovich B, Bates W (1949) Pain Syndromes, 3rd edn. In: FA Davis (ed) Philadelphia, pp 46–51
Wallace LA (1986) Limb length difference and back pain. In: Gregory P Grieve (ed) Modem manual therapy of the vertebral column. Churchill Livingstone, Edinburgh, p 466
Lankford (1982) Reflex sympathetic dystrophy. In: Green DP (ed) Operative hand surgery. Churchill Livingston, New York, pp 539–562
Laskin DM (1969) Etiology of the Pain-Dysfunction syndrome. J Am Dent Assoc 79: 147–153
Llewellyn LJ, Jones AB (1915) Fibrositis. Rebman, New York
MacKinnon SE, Dellon Al (1988) Surgery of peripheral nerves. Brachial plexus compression (Thoracic Outlet Syndrome). Thieme Med Publ, New York, p 363
Mikhail M, Rosen H (1980) History and etiology of Myofascial Pain-Dysfunction syndrome. J Prosthet Dent 44: 438–444
Moldofsky H (1982) Rheumatic pain modulation syndrome: the interrelationship between sleep, central nervous system, serotonin and pain. In: Critchley M, Friedman A, Gorini S, Sicuteri F (eds) Advance in neurology. Raven Press, New York 33: 51
Moldofsky H, Scarisbrick P, England R (1975) Musculoskeletal symptoms and “non-REM” disturbances in patients with “fiobrositic syndrome and healthy subjects. Psychosom Med 4: 341
Travel J, Rinzler S (1952) The myofascial genesis of pain. Postgrad Med 11: 425–434
Travel J, Simons DG (1983) Myofascial pain and dysfunction. The trigger points manual. Williams Wilkins Baltimore, London
Wilbourn AJ (1990) The Thoracic Outlet Syndrome is over-diagnosed. Controversies in neurology. Arch Neurol 47: 327–330
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© 2005 Springer-Verlag
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Crotti, F.M. et al. (2005). TOS pathophysiology and clinical features. In: Alexandre, A., Bricolo, A., Millesi, H. (eds) Advanced Peripheral Nerve Surgery and Minimal Invasive Spinal Surgery. Acta Neurochirurgica, vol 97. Springer, Vienna. https://doi.org/10.1007/3-211-27458-8_2
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DOI: https://doi.org/10.1007/3-211-27458-8_2
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