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Maślanka K, Zielinska N, Karauda P, Balcerzak A, Georgiev G, Borowski A, Drobniewski M, Olewnik Ł. Congenital, Acquired, and Trauma-Related Risk Factors for Thoracic Outlet Syndrome-Review of the Literature. J Clin Med 2023; 12:6811. [PMID: 37959276 PMCID: PMC10648912 DOI: 10.3390/jcm12216811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Thoracic outlet syndrome is a group of disorders that affect the upper extremity and neck, resulting in compression of the neurovascular bundle that exits the thoracic outlet. Depending on the type of compressed structure, the arterial, venous, and neurogenic forms of TOS are distinguished. In some populations, e.g., in certain groups of athletes, some sources report incidence rates as high as about 80 cases per 1000 people, while in the general population, it is equal to 2-4 per 1000. Although the pathogenesis of this condition appears relatively simple, there are a very large number of overlapping risk factors that drive such a high incidence in certain risk groups. Undoubtedly, a thorough knowledge of them and their etiology is essential to estimate the risk of TOS or make a quick and accurate diagnosis.
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Affiliation(s)
- Krystian Maślanka
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-419 Lodz, Poland; (K.M.); (N.Z.); (P.K.); (A.B.)
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-419 Lodz, Poland; (K.M.); (N.Z.); (P.K.); (A.B.)
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-419 Lodz, Poland; (K.M.); (N.Z.); (P.K.); (A.B.)
| | - Adrian Balcerzak
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-419 Lodz, Poland; (K.M.); (N.Z.); (P.K.); (A.B.)
| | - Georgi Georgiev
- Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna—ISUL, Medical University of Sofia, 1527 Sofia, Bulgaria;
| | - Andrzej Borowski
- Orthopaedics and Paediatric Orthopaedics Department, Medical University of Lodz, 90-419 Lodz, Poland; (A.B.); (M.D.)
| | - Marek Drobniewski
- Orthopaedics and Paediatric Orthopaedics Department, Medical University of Lodz, 90-419 Lodz, Poland; (A.B.); (M.D.)
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-419 Lodz, Poland; (K.M.); (N.Z.); (P.K.); (A.B.)
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Szaro P, Suresh R, Molokwu B, Sibala DR, Mendiratta D, Chu A, McGrath A. Magnetic resonance imaging for diagnosis of suspected neurogenic thoracic outlet syndrome-a systematic scoping review. Front Physiol 2023; 14:1198165. [PMID: 37920804 PMCID: PMC10619157 DOI: 10.3389/fphys.2023.1198165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/06/2023] [Indexed: 11/04/2023] Open
Abstract
Background: Neurogenic Thoracic Outlet Syndrome (nTOS) is a rare pathology caused by dynamic conditions or compression of neurovascular structures in the thoracic outlet region. nTOS can be difficult to diagnose due to nonspecific symptoms and magnetic resonance imaging (MRI) techniques are increasingly used to aid the diagnosis and surgical planning. This scoping systematic review explores how MRI is used for diagnosing nTOS and summarizes details of published MRI protocols. Methods: A systematic screening of PubMed, Cochrane, Web of Science, and CINAHL databases using PRISMA-IPD guidelines was conducted in September 2022 to include full-text English papers on MRI and nTOS. Inclusion criteria involved studies describing MRI protocols for the diagnosis of TOS, with a focus on the imaging sequences and protocols. Results: 6289 papers were screened to include 28 papers containing details of MRI protocols. The details of MRI protocols in the analyzed articles were incomplete in all studies. Most authors used 1.5T systems and included T1 and T2-weighted sequences. Most studies applied fat suppression, mainly with STIR. Positioning of the arm differed between studies, including neutral, hyperabducted and abducted and externally rotated positions. Conclusion: Our review highlights a prevalent lack of detailed MRI protocol documentation for brachial plexus. Authors primarily rely on conventional 1.5T systems, employing standard T1 and T2-weighted sequences. The adoption of novel MRI sequences is notably lacking, and fat suppression techniques predominantly adhere to older methods as STIR. There is a clear imperative for authors to provide more comprehensive reporting of the MRI protocols utilized in their studies, ultimately enhancing comparability and clinical applicability. Establishing clear protocol reporting guidelines is crucial to allow for comparison between studies.
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Affiliation(s)
- Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rohan Suresh
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Brian Molokwu
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Dhiraj Raju Sibala
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Dhruv Mendiratta
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Alice Chu
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Aleksandra McGrath
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Boglione M, Ortíz R, Teplisky D, Giuseppucci C, Korman L, Reusmann A, Barrenechea M. Surgical treatment of thoracic outlet syndrome in pediatrics. J Pediatr Surg 2022; 57:29-33. [PMID: 34563357 DOI: 10.1016/j.jpedsurg.2021.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
AIM Thoracic outlet syndrome (TOS) is a condition that occurs when the cervical neuro-vascular bundle becomes compressed at one of the three narrow areas of the thoraco-cervico-axillary region. Conservative management is the first line of treatment. Patients who do not respond to conservative management should be treated surgically. The aim of this review is to present our experience with the surgical management of TOS in pediatric patients. METHODS We retrospectively reviewed the outcomes of all patients with TOS operated at our Hospital between 2001 and 2020. We collected all demographic data, clinical features, imaging data, type of operation performed, intraoperative findings, complications and recurrence. RESULTS We operated 9 patients within the study period. The median age at surgery was 14 (7 to 17) years. A transaxillary approach was used in 7 patients and a supraclavicular approach in 2. There was only one minor intraoperative complication (violation of the pleural space). There were no postoperative complications. The median length of stay was 3 (2 to 4) days. All patients were extubated in the operating room. Two patients developed symptoms on the contralateral side. One of these underwent a successful contralateral transaxillary Roos operation. The follow-up was 4 months to 20 years. All patients are asymptomatic. CONCLUSION We believe that the Roos operation is a safe and effective treatment with excellent long-term outcomes for children with TOS that fail conservative management.
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Affiliation(s)
- Mariano Boglione
- General Surgery, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
| | - Ramiro Ortíz
- General Surgery, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Darío Teplisky
- Interventional Radiology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Carlos Giuseppucci
- General Surgery, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Luciano Korman
- General Surgery, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Aixa Reusmann
- General Surgery, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Marcelo Barrenechea
- General Surgery, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Farina R, Foti PV, Conti A, Iannace FA, Pennisi I, Fanzone L, Inì C, Libra F, Vacirca F, Failla G, Baldanza D, Palmucci S, Santonocito S, Basile A. The role of ultrasound imaging in vascular compression syndromes. Ultrasound J 2021; 13:4. [PMID: 33555480 PMCID: PMC7870731 DOI: 10.1186/s13089-020-00202-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022] Open
Abstract
Vascular compression syndromes are rare alterations that have in common the compression of an arterial and/or venous vessel by contiguous structures and can be congenital or acquired. The best known are the Thoracic Outlet Syndrome, Nutcracker Syndrome, May–Thurner Syndrome, and Dunbar Syndrome. The incidence of these pathologies is certainly underestimated due to the non-specific clinical signs and their frequent asymptomaticity. Being a first-level method, Ultrasound plays a very important role in identifying these alterations, almost always allowing a complete diagnostic classification. If in expert hands, this method can significantly contribute to the reduction of false negatives, especially in the asymptomatic population, where the finding of the aforementioned pathologies often happens randomly following routine checks. In this review, we briefly discuss the best known vascular changes, the corresponding ultrasound anatomy, and typical ultrasound patterns.
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Affiliation(s)
- Renato Farina
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy.
| | - Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Andrea Conti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Francesco Aldo Iannace
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Isabella Pennisi
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Luigi Fanzone
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Corrado Inì
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Federica Libra
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Francesco Vacirca
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Giovanni Failla
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Davide Baldanza
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Serafino Santonocito
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
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Masocatto NO, Da-Matta T, Prozzo TG, Couto WJ, Porfirio G. Thoracic outlet syndrome: a narrative review. ACTA ACUST UNITED AC 2019; 46:e20192243. [PMID: 31859722 DOI: 10.1590/0100-6991e-20192243] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 07/15/2019] [Indexed: 12/29/2022]
Abstract
The Thoracic Outlet Syndrome (TOS) results from compression of the brachial plexus, the subclavian artery and the subclavian vein in the thoracic outlet region. This compression may take place between the clavicle and the first rib or by a number of anatomical variations. Neurological compression is the most common form of thoracic outlet syndrome. Vascular complications occur infrequently. Arterial complications usually result from compression of the subclavian artery by a complete cervical rib. Venous complications are often related to muscle compression of the subclavian vein. The neurogenic form, previously described, is the most common, constituting more than 95% of cases, while the venous represents 2% to 3%, and the arterial, about 1%. Risk factors include biotype and individual variations such as genetics, age and gender. In Brazil, there are no data on the epidemiology of TOS. Given the suspicion of TOS, a detailed clinical evaluation is necessary, followed by complementary exams to elucidate the cause. The treatment is directed according to the etiology and the presence or absence of complications. The purpose of this study was to perform a narrative review on TOS, focusing on its etiology, pathophysiology, epidemiology, clinical evaluation, complementary exams, differential diagnoses, and treatment.
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Affiliation(s)
- Nilo Olímpio Masocatto
- Universidade Municipal de São Caetano do Sul (USCS), Curso de Medicina, São Caetano do Sul, SP, Brasil
| | - Thales Da-Matta
- Universidade Municipal de São Caetano do Sul (USCS), Curso de Medicina, São Caetano do Sul, SP, Brasil
| | - Thauane Garcia Prozzo
- Universidade Municipal de São Caetano do Sul (USCS), Curso de Medicina, São Caetano do Sul, SP, Brasil
| | - Wilson José Couto
- Universidade Municipal de São Caetano do Sul (USCS), Curso de Medicina, São Caetano do Sul, SP, Brasil.,Universidade Municipal de São Caetano do Sul (USCS), Curso de Medicina, Departamento de Cirurgia, Disciplina de Cirurgia Torácica, São Caetano do Sul, SP, Brasil
| | - Gustavo Porfirio
- Universidade Municipal de São Caetano do Sul (USCS), Curso de Medicina, São Caetano do Sul, SP, Brasil
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Kuo AH, Nagpal P, Ghoshhajra BB, Hedgire SS. Vascular magnetic resonance angiography techniques. Cardiovasc Diagn Ther 2019; 9:S28-S36. [PMID: 31559152 DOI: 10.21037/cdt.2019.06.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Magnetic resonance angiography (MRA) denotes a unique option for the evaluation of peripheral vasculature due to its noninvasive nature, lack of ionizing radiation exposure, potential for non-contrast examination, and ability for generating volumetric representations that showcase vascular pathology. The constant evolution of the available MRA techniques, however, makes understanding and determining an optimal imaging protocol difficult. Here we present a brief overview of the major MRA sequence options, their major weaknesses and strengths, and related imaging considerations. Understanding the technical underpinnings of the various MRA methods helps with recognition of common imaging issues and artifacts and rendering clinically relevant interpretations.
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Affiliation(s)
- Anderson H Kuo
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa/Carver College of Medicine, Iowa City, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sandeep S Hedgire
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Stecco A, Pirri C, Stecco C. Fascial entrapment neuropathy. Clin Anat 2019; 32:883-890. [PMID: 31004463 DOI: 10.1002/ca.23388] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/16/2019] [Indexed: 12/26/2022]
Abstract
Entrapment neuropathies are debilitating clinical conditions, creating significant morbidity in the upper and lower extremities in terms of pain, sensory abnormalities, and motor weakness, becoming a challenge to diagnose and treat. Because entrapments can have multiple origins, a misinterpretation of anatomy during examination can lead to incorrect diagnosis and treatment. This review addresses understanding of the anatomy of fascia that can play an important role in this syndrome. There is a specific microenvironment around the nerve composed of connective tissues that include deep fascia, intermuscular septa, epineurium, and perineurium. The microenvironmental modifications can be translated into change in mobility with consequence decreasing of the independency of the nerve from the surrounding structures lading to entrapments and "internal stretch lesion." The entrapments reported in this article reinforce the importance of fascia tissue in generating common symptoms that pose more difficult diagnostic challenges and may often be confused with more common clinical conditions. Clin. Anat. 32:883-890, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Antonio Stecco
- RUSK Rehabilitation, New York University School of Medicine, New York, New York
| | - Carmelo Pirri
- Physical and Rehabilitation Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Carla Stecco
- Molecular Medicine Department, University of Padua, Padua, Italy
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Costales JR, Socolovsky M, Sánchez Lázaro JA, Costales DR. Peripheral nerve injuries in the pediatric population: a review of the literature. Part II: entrapment neuropathies. Childs Nerv Syst 2019; 35:37-45. [PMID: 30209596 DOI: 10.1007/s00381-018-3975-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Entrapment neuropathies are infrequent in children, and therefore remain unrecognized. The incidence of radial, median, and cubital mononeuropathies are all similar. Despite the rarity of such cases, extensive, albeit scattered, literature has accumulated concerning entrapment neuropathies in children. OBJECTIVE To the literature concerning entrapment neuropathies in children. METHODS A systematic review of the existing literature has been made. RESULTS The management of chronic pediatric pain is very important in such patients to prevent youths from experiencing prolonged absences from school, sports, or other productive activities, and limit the psychological burden of chronic disease. Nonsurgical treatment of both cubital and carpal tunnel syndromes has been disappointing in pediatric patients, with only limited success; and, to date, there is no clear explanation for the outcome differences generated by nonsurgical management between adults and youths. Simple decompression of the ulnar nerve at the elbow also has much higher rates of failure in children than in adults. CONCLUSIONS The presence of an entrapment neuropathy (specially carpal tunnel syndrome) in a pediatric-age patient should alert medical care providers to the potential of some underlying genetic condition or syndrome.
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Affiliation(s)
| | - Mariano Socolovsky
- Peripheral Nerve & Brachial Plexus Surgery Program, Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
| | | | - David Robla Costales
- Department of Plastic Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
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Two-point mDIXON turbo spin-echomagnetic resonance imaging of thoracic outlet syndrome at 3-T for robust fat suppression. Pediatr Radiol 2018; 48:287-288. [PMID: 29080124 DOI: 10.1007/s00247-017-4008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
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