1/55. AAEM case report 33: costoclavicular mass syndrome. American association of Electrodiagnostic medicine.A true costoclavicular mass syndrome associated with a brachial plexopathy is rare. We report the occurrence of a severe brachial plexopathy as a late complication of a displaced midclavicular fracture. An exuberant callus associated with the clavicular fracture acted as a mass lesion to compress the brachial plexus within the costoclavicular space (i.e., between the clavicle and the first rib). The clinical features and the electrodiagnostic findings in this patient were crucial in suggesting the diagnosis, which was subsequently confirmed by radiographic studies and surgical exploration. Surgical excision of the hyperabundant callus and freeing of the entrapped brachial plexus resulted in marked improvement of the patient's neurological symptoms. Recognition of this uncommon complication of a clavicular fracture is important for the timely diagnosis of this treatable problem.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/55. thoracic outlet syndrome in aquatic athletes.thoracic outlet syndrome is a well-recognized group of symptoms resulting from compression of the subclavian artery and vein, as well as the brachial plexus, within the thoracic outlet. Symptoms are related directly to the structure that is compressed. diagnosis is difficult because there is no single objective, reliable test; therefore, diagnoses of thoracic outlet syndrome is based primarily on a set of historical and physical findings, supported and corroborated by a host of standard tests. Because aquatic athletes are primarily "overhead" athletes, one may expect a higher incidence of thoracic outlet syndrome in this population. The differential between TOS and "swimmer's shoulder" (multidirectional instability and subacromial impingement) may be difficult. Nonsurgical treatment methods can be helpful in relieving symptoms; in certain recalcitrant cases, however, surgical intervention can provide lasting relief and a return to aquatic athletics.- - - - - - - - - - ranking = 9.228303379921keywords = compression (Clic here for more details about this article) |
3/55. Cervical root stimulation in a case of classic neurogenic thoracic outlet syndrome.We performed C8 nerve root stimulation in addition to other electromyographic (EMG) studies in a surgically proven case of classic thoracic outlet syndrome (TOS). The patient was a 19-year-old woman with a 2-year history of right hand cramps and progressive weakness and atrophy of hand muscles, especially the thenar eminence. Routine EMG studies showed evidence for an axon-loss lower trunk brachial plexopathy. Stimulation studies of the C8 nerve roots demonstrated proximal conduction block on the affected side only. The diagnosis was further supported by cervical spine radiographs, which demonstrated a cervical rib, and surgical exploration of the brachial plexus, which demonstrated upward compression and stretching of the lower trunk by a fascial band extending from the anomalous cervical rib to the first thoracic rib. The patient noted a modest improvement in hand function postoperatively. Root stimulation studies can help in the diagnosis of classic TOS by providing more precise localization and information regarding the degree, if any, of proximal motor conduction block.- - - - - - - - - - ranking = 9.228303379921keywords = compression (Clic here for more details about this article) |
4/55. diagnosis of vascular compression at the thoracic outlet using gadolinium-enhanced high-resolution ultrafast MR angiography in abduction and adduction.gadolinium-enhanced magnetic resonance angiography allows rapid evaluation of the vascular structures of the thoracic outlet both in the neutral position and in abduction during one examination within FDA-approved dose limitations for contrast agents. The technique appears to be a good screening one for patients suspected of having vascular thoracic outlet syndrome.- - - - - - - - - - ranking = 36.913213519684keywords = compression (Clic here for more details about this article) |
5/55. Superior vena cava thrombosis secondary to thoracic outlet syndrome. Case report.A case of superior vena cava thrombosis secondary to the thoracic outlet syndrome is reported. The diagnosis was revealed by CT-scan and confirmed by phlebography performed to insert a catheter for intrathrombotic infusion of urokinase. The thrombolytic treatment was followed by complete clot lysis. A hyperabduction manoeuvre confirmed costoclavicular compression as the cause of the subclavian-axillary vein thrombosis for which the patient underwent first rib resection. Axillary-subclavian vein thrombosis (or Paget-von Schroetter syndrome) is a relatively frequent complication of the thoracic outlet syndrome often treated with anticoagulants on the basis of a duplex examination. Involvement of the superior vena cava is not readily detected by duplex ultrasound so a partial thrombosis, with a possible fatal outcome could remain undiagnosed. Full investigation by phlebography or CT-scan is therefore recommended. In addition, transcatheter thrombolytic therapy has a lower incidence of follow-up complications than heparin.- - - - - - - - - - ranking = 9.228303379921keywords = compression (Clic here for more details about this article) |
6/55. thoracic outlet syndrome caused by first rib hemangioma.We report a case of first rib hemangioma that caused thoracic outlet syndrome. A 50-year-ole woman who was admitted to our hospital with a clinical diagnosis of thoracic outlet syndrome presented with fullness and easy fatigue of her right arm. Her right arm discomfort was associated with intermittent engorgement of superficial veins over the shoulder girdle. A chest radiograph revealed an enlargement of the anterior aspect of the first rib with fine bony trabeculations. Computed tomography scan showed contrast enhancement over the enlarged rib. Our tentative preoperative diagnosis was a benign first rib hypertrophic change, such as an old fracture with exuberant callus formation. A right-arm venogram revealed a patent subclavian vein with an extrinsic compression, which occluded on arm abduction. The findings of neural conduction studies of both upper extremities were symmetric and normal. The patient agreed to surgery because of the occlusive condition of the subclavian vein on arm abduction and progressive arm weakness in recent months. Segmental transection of the offending portion of the enlarged first rib was complicated by difficulty in isolating the whole length of the compressed but normal-appearing subclavian vein by our initial transaxillary and infraclavicular approaches because the medial aspect of the subclavian vein was obstructed by the enlarged first rib, which extended medially to the junction of the right jugular and subclavian veins. Successful segmental transection of the enlarged first rib was finally accomplished by combined transaxillary, infraclavicular, and supraclavicular approaches. A moderate amount of rib bleeding from resection ends was noted during segmental resection of the enlarged first rib, resulting in local hematoma formation. A 470-mL bloody discharge was collected from the vacuum ball inserted via the transaxillary route during her 12-day hospitalization. Pathologic examination revealed an intraosseous hemangioma. The patient had a prolonged course to partial recovery of her arm numbness, but signs of venous compression were much improved at 6 months' follow-up. Although hemangioma is benign, its hypervascular nature may cause catastrophic intraoperative bleeding.- - - - - - - - - - ranking = 18.789940093175keywords = compression, fracture (Clic here for more details about this article) |
7/55. Hypertrophic non-union of the first rib causing thoracic outlet syndrome: a case report.We experienced a rare case of thoracic outlet syndrome caused by hypertrophic nonunion of the first rib. A diagnosis was made mainly upon provocative tests and imaging studies. pain and tingling could be reproduced and the radial pulse obliterated by the hyperabduction test. Abundant callus formation on the posterior aspect of the first rib with fracture line was visible on plain radiograph. Two-dimensional computed tomography showed right thoracic outlet narrowing mainly caused by the mass-effect of the callus. Dynamic arteriographic studies revealed an external compression of the right subclavian artery and duplex ultrasonography demonstrated a reduction in right subclavian artery blood flow when the shoulder is in 90 degrees of abduction. Surgery was performed after the conservative management for three months which failed to relieve the patient of his complaints. Resection of the first rib via transaxillary approach was undergone uneventfully in combination with the myotomy of the scalenus anticus muscle. At postoperative one year follow up, the patient was free of symptoms, and had a full range of motion of the right shoulder with no evidence of arterial insufficiency.- - - - - - - - - - ranking = 9.5616367132543keywords = compression, fracture (Clic here for more details about this article) |
8/55. thoracic outlet syndrome with subclavian aneurysm in a very young child: the complementary value of MRA and 3D-CT in diagnosis.thoracic outlet syndrome (TOS) is rare in childhood. In adults, TOS results in compression of the neurovascular bundle (branches of the brachial plexus and the subclavian artery), but more than 95% of cases present solely with neurologic compression. We present a case of TOS in a very young child and describe the rare finding of subclavian artery compression and post-stenotic aneurysm. The clinical features, imaging workup, and surgical findings are discussed. The combination of three-dimensional MR angiography and CT was of great value in diagnosis and surgical planning.- - - - - - - - - - ranking = 27.684910139763keywords = compression (Clic here for more details about this article) |
9/55. Normative values for high voltage electrical stimulation across the brachial plexus.OBJECTIVES: To obtain normative values for High Voltage Electrical Stimulation across the brachial plexus between Erb's point, C8 root and T1 root. A case study of probable true thoracic outlet syndrome is used to illustrate the usefulness of the method. methods: 22 patients were tested for use in normative date pool with complaints unrelated to the ulnar nerve, the majority of which were pure carpal tunnel syndrome. High voltage stimulation was performed at Erb's point, C8 root and T1 root. Recording was from the abductor digit minimi muscle. RESULTS: Upper limit for absolute latencies were 13.9 ms, 14.5 ms and 14.5 ms for Erb's point, C8 root and T1 root stimulation respectively. Corresponding lower limits of amplitude were 4.8 mV, 3.4 mV and 2.9 mV. Upper limits for interpeak latencies were 1.4 ms and 1.2 ms for C8 to Erb's point and T1 to Erb's point respectively. In a case of true thoracic outlet syndrome, the symptomatic side revealed prolonged interpeak and absolute latencies. The asymptomatic side remained within normal limits. CONCLUSION: Normative values for high voltage stimulation across the brachial plexus are useful in cases of suspected compression in this proximal location of the upper limb.- - - - - - - - - - ranking = 9.228303379921keywords = compression (Clic here for more details about this article) |
10/55. Thoracic outlet compression syndrome.Forty-nine patients underwent sixty-four procedures for the treatment of the thoracic outlet compression syndrome. Detailed history and careful physical examination are of paramount importance in diagnosing this disease. Our findings strongly suggest that a positive arteriogram is confirmatory evidence of the thoracic outlet compression syndrome. Two problems are identified as the source of unsatisfactory results in this series: poor selection of patients and the regeneration of rib and dense scar tissue with recurrence of compression symptoms. We favor the transaxillary approach to resection of the first rib because it provides satisfactory exposure for removal of the entire rib and utilizes a more cosmetically pleasing incision. Division of muscles, traction on nerves, and entrance into a body cavity are not required, operating time and hospital stay are shortened, and blood loss is minimized. Favorable long-term results were seen in 86 per cent of the patients treated.- - - - - - - - - - ranking = 64.598123659447keywords = compression (Clic here for more details about this article) |
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