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Lecoq S, Hersant J, Abraham P. Estimation of the prevalence of isolated inter-scalene compression from simultaneous arterial and venous photoplethysmography in patients referred for suspected thoracic outlet syndrome. Physiol Meas 2024; 45:085002. [PMID: 39029492 DOI: 10.1088/1361-6579/ad65b1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/19/2024] [Indexed: 07/21/2024]
Abstract
Objective.In patients with suspected thoracic outlet syndrome (TOS), diagnosing inter-scalene compression could lead to minimally invasive treatments. During photo-plethysmography, completing a 30 s 90° abduction, external rotation ('surrender' position) by addition of a 15 s 90° antepulsion 'prayer' position, allows quantitative bilateral analysis of both arterial (A-PPG) and venous (V-PPG) results. We aimed at determining the proportion of isolated arterial compression with photo-plethysmography in TOS-suspected patients.Approach.We studied 116 subjects recruited over 4 months (43.3 ± 11.8 years old, 69% females). Fingertip A-PPG and forearm V-PPG were recorded on both sides at 125 Hz and 4 Hz respectively. A-PPG was converted to PPG amplitude and expressed as percentage of resting amplitude (% rest). V-PPG was expressed as percentage of the maximal value (% max) observed during the 'Surrender-Prayer' maneuver. Impairment of arterial inflow during the surrender (As+) or prayer (Ap+) phases were defined as a pulse-amplitude either <5% rest, or <25% rest. Incomplete venous emptying during the surrender (Vs+) or prayer (Vp+) phases were defined as V-PPG values either <70% max, or <87% max.Main results.Of the 16 possible associations of encodings, As - Vs - Ap - Vp- was the most frequent observation assumed to be a normal response. Isolated arterial inflow without venous outflow (As + Vs-) impairment in the surrender position was observed in 10.3% (95%CI: 6.7%-15.0%) to 15.1% (95%CI: 10.7%-20.4%) of limbs.Significance.Simultaneous A-PPG and V-PPG can discriminate arterial from venous compression and then potentially inter-scalene from other levels of compressions. As such, it opens new perspectives in evaluation and treatment of TOS.
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Affiliation(s)
- Simon Lecoq
- Médecine du sport, CHU Angers, F-49000 Angers, France
- Médecine Vasculaire, CHU Angers, F-49000 Angers, France
- Université Angers, CHU Angers, Inserm, CNRS, MITOVASC, Équipe CARME, SFR ICAT, Angers, F-49000, France
| | - Jeanne Hersant
- Médecine Vasculaire, CHU Angers, F-49000 Angers, France
- Université Angers, CHU Angers, Inserm, CNRS, MITOVASC, Équipe CARME, SFR ICAT, Angers, F-49000, France
| | - Pierre Abraham
- Médecine du sport, CHU Angers, F-49000 Angers, France
- Médecine Vasculaire, CHU Angers, F-49000 Angers, France
- Université Angers, CHU Angers, Inserm, CNRS, MITOVASC, Équipe CARME, SFR ICAT, Angers, F-49000, France
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Wang D, Chen P, Jia F, Wang M, Wu J, Yang S. Division of neuromuscular compartments and localization of the center of the highest region of muscle spindles abundance in deep cervical muscles based on Sihler's staining. Front Neuroanat 2024; 18:1340468. [PMID: 38840810 PMCID: PMC11151460 DOI: 10.3389/fnana.2024.1340468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
Purpose The overall distribution pattern of intramuscular nerves and the regions with the highest spindle abundance in deep cervical muscles have not been revealed. This study aimed to reveal neuromuscular compartmentalization and localize the body surface position and depth of the center of the region of highest muscle spindle abundance (CRHMSA) in the deep cervical muscles. Methods This study included 36 adult cadavers (57.7 ± 11.5 years). The curved line joining the lowest point of the jugular notch and chin tip was designated as the longitudinal reference line (line L), and the curved line connecting the lowest point of the jugular notch and acromion was designated as the horizontal reference line (line H). Modified Sihler's staining, hematoxylin-eosin staining and computed tomography scanning were employed to determine the projection points (P) of the CRHMSAs on the anterior surfaces of the neck. The positions (PH and PL) of point P projected onto the H and L lines, and the depth of each CRHMSA, and puncture angle were determined using the Syngo system. Results The scalenus posterior and longus capitis muscles were divided into two neuromuscular compartments, while the scalenus anterior and longus colli muscles were divided into three neuromuscular compartments. The scalenus medius muscle can be divided into five neuromuscular compartments. The PH of the CRHMSA of the scalenus muscles (anterior, medius, and posterior), and longus capitis and longus colli muscles, were located at 36.27, 39.18, 47.31, 35.67, and 42.71% of the H line, respectively. The PL positions were at 26.53, 32.65, 32.73, 68.32, and 51.15% of the L line, respectively. The depths of the CRHMSAs were 2.47 cm, 2.96 cm, 2.99 cm, 3.93 cm, and 3.17 cm, respectively, and the puncture angles were 87.13°, 85.92°, 88.21°, 58.08°, and 77.75°, respectively. Conclusion Present research suggests that the deep cervical muscles can be divided into neuromuscular compartments; we recommend the locations of these CRHMSA as the optimal target for administering botulinum toxin A injections to treat deep cervical muscle dystonia.
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Affiliation(s)
| | | | | | | | | | - Shengbo Yang
- Department of Human Anatomy, Zunyi Medical University, Zunyi, China
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Issa TZ, Lin JS, Herrera F, Mailey B. Trends in the Surgical Management of Thoracic Outlet Syndrome. Hand (N Y) 2024; 19:367-373. [PMID: 36544244 PMCID: PMC11067839 DOI: 10.1177/15589447221141479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The operative treatment for thoracic outlet syndrome (TOS) varies in the United States. This may be due to differences in specialty training of the provider. We sought to identify which procedures are primarily performed by specialty, identify patient characteristics presenting for different neurogenic TOS surgical interventions, and describe the safety of TOS surgery. METHODS Patients treated for neurogenic TOS between 2016 and 2018 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Patient characteristics, surgeon details, intraoperative variables, and complication outcomes were abstracted. Patient cohorts were stratified by type of operative intervention and by treating specialty. RESULTS Transthoracic first rib resection was the most common procedure performed for TOS relief (46.1%), followed by division of the scalene muscles with rib resection (23.9%) and brachial plexus exploration with decompression (19.4%). Vascular surgeons performed 87% of TOS repairs. Thirty-day complication rate was 3.5%. Addition of scalenectomy to first rib resection was common and resulted in increased operative time but did not increase early complication rate or readmission rate. CONCLUSION Patient characteristics and dispositions are similar between the various TOS operative approaches. All major surgical treatments for TOS have low complication rates. Transthoracic first rib resection performed by vascular surgeons remains the most common surgical treatment for patients with TOS in the United States. Despite neurogenic symptoms representing most cases, less than 10% of operations are performed by peripheral nerve specialists, highlighting a potential need for greater incorporation of TOS release into peripheral nerve practices.
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Fouasson-Chailloux A, Jager T, Daley P, Falcone A, Duysens C, Estoppey D, Merle M, Pomares G. Possible role of the botulinum toxin in the management of neurogenic thoracic outlet syndrome: a systematic review. Eur J Phys Rehabil Med 2023; 59:706-713. [PMID: 37737048 PMCID: PMC10797639 DOI: 10.23736/s1973-9087.23.07815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/31/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Thoracic outlet syndrome (TOS) is related to the compression and/or the traction of the upper-limb neurovascular bundle, responsible for a chronic painful impairment. Neurogenic TOS (NTOS) is the most common manifestation. It remains a challenging diagnosis and its treatment is also difficult. Botulinum toxin (BTX) has been described to help both the diagnosis and the symptoms improvement. EVIDENCE ACQUISITION A systematic literature research was performed using PubMed, ScienceDirect, and Embase databases to collect studies reporting the use of BTX in NTOS management. We followed the PRISMA guidelines, and the included studies were evaluated using the GRADE approach. EVIDENCE SYNTHESIS We included 10 original articles representing 555 patients. Various outcomes were considered, and results varied from a study to another. Symptoms relief varied from an absence of BTX effectiveness to 84.1% of improvement; relief duration was also reported from none to 88 days. BTX injections were debatable predictors of surgical procedure successes due to low evidence. There was a huge gap between the studies concerning side-effects of the BTX procedures, from none to 100% of the patients. CONCLUSIONS There is no evidence for considering BTX injection as a validated tool for the management of NTOS. There might be a slight effect on symptoms, but outcomes are very variable, which prevents further interpretations. The use of BTX should be evaluated in larger prospective cohorts with more standardized outcomes.
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Affiliation(s)
- Alban Fouasson-Chailloux
- European Hand Institute, Luxembourg, Luxembourg -
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg -
- Service of Motor and Respiratory Physical and Rehabilitation Medicine, Nantes University, CHU Nantes, Nantes, France -
- Regional Institute of Sports Medicine (IRMS), St Jacques Hospital, Nantes, France -
| | - Thomas Jager
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Pauline Daley
- Service of Motor and Respiratory Physical and Rehabilitation Medicine, Nantes University, CHU Nantes, Nantes, France
- Regional Institute of Sports Medicine (IRMS), St Jacques Hospital, Nantes, France
| | - Andrea Falcone
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Christophe Duysens
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Daniel Estoppey
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Michel Merle
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
| | - Germain Pomares
- European Hand Institute, Luxembourg, Luxembourg
- Medical Training Center, Kirchberg Hospital, Luxembourg, Luxembourg
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Blondin M, Garner GL, Hones KM, Nichols DS, Cox EA, Chim H. Considerations for Surgical Treatment of Neurogenic Thoracic Outlet Syndrome: A Meta-Analysis of Patient-Reported Outcomes. J Hand Surg Am 2023:S0363-5023(23)00121-1. [PMID: 37055338 DOI: 10.1016/j.jhsa.2023.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/13/2023] [Accepted: 03/08/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE It remains unclear whether the first rib resection, performed via a supraclavicular (SCFRR) or transaxillary (TAFRR) approach, is necessary for patients with neurogenic thoracic outlet syndrome (nTOS). In a systematic review and meta-analysis, we performed a direct comparison of patient-reported functional outcomes following different surgical approaches for nTOS. METHODS The authors searched PubMed, Embase, Web of Science, Cochrane Library, PROSPERO, Google Scholar, and the gray literature. Data were extracted based on the procedure type. Well-validated patient-reported outcome measures were analyzed in separate time intervals. Random-effects meta-analysis and descriptive statistics were used where appropriate. RESULTS Twenty-two articles were included, with 11 discussing SCFRR (812 patients), 6 discussing TAFRR (478 patients), and 5 discussing rib-sparing scalenectomy (RSS; 720 patients). The mean difference between preoperative and postoperative Disabilities of the Arm, Shoulder and Hand score was significantly different comparing RSS (43.0), TAFRR (26.8), and SCFRR (21.8). The mean difference between preoperative and postoperative visual analog scale scores was significantly higher for TAFRR (5.3) compared to SCFRR (3.0). Derkash scores were significantly worse for TAFRR compared to RSS or SCFRR. RSS had a success rate of 97.4% based on Derkash score, followed by SCFRR and TAFRR at 93.2% and 87.9%, respectively. RSS had a lower complication rate compared to SCFRR and TAFRR. There was a difference in complication rates: 8.7%, 14.5%, and 3.6% for SCFRR, TAFRR, and RSS, respectively. CONCLUSIONS Mean differences in Disabilities of the Arm, Shoulder and Hand scores and Derkash scores were significantly better for RSS. Higher complication rates were reported after the first rib resection. Our findings suggest that RSS is an effective option for the treatment of nTOS. TYPE OF STUDY/ LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Mario Blondin
- College of Medicine, University of Florida, Gainesville, FL
| | | | - Keegan M Hones
- College of Medicine, University of Florida, Gainesville, FL
| | | | | | - Harvey Chim
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL.
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Diner C, Mathieu L, Vandendries C, Oberlin C, Belkheyar Z. Elective brachial plexus decompression in neurogenic thoracic outlet syndrome. HAND SURGERY & REHABILITATION 2023; 42:9-14. [PMID: 36574580 DOI: 10.1016/j.hansur.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/28/2022]
Abstract
We aimed to evaluate functional outcome following elective brachial plexus decompression by compressive fibrous band resection and limited on-demand bone abnormality resection in patients with neurogenic thoracic outlet syndrome (N-TOS). A retrospective continuous observational study was conducted in 17 patients (15 women and 2 men), with a mean age of 42 years, operated on between 2013 and 2021. Twenty brachial plexus decompressions were performed, for 13 objective and 7 subjective N-TOSs, including 3 recurrent N-TOSs. At last follow-up, outcomes were evaluated in terms of residual pain, paresthesia and hand motor deficit, plus patient-reported assessment and Quick-DASH functional scoring. No postoperative complications occurred. At a median follow-up of 12 months (range 6-48 months), complete pain relief and paresthesia resolution were found in 11/15 and 9/14 cases, respectively. All patients reported that their symptoms had improved. In contrast, hand muscle atrophy persisted in all cases (n = 11). Sensorimotor recovery seemed to be poorer and mean Quick-DASH score better in objective than subjective N-TOS patients. Elective brachial plexus decompression seemed to be a safe procedure, providing constant improvement in subjective symptoms related to lower trunk irritation. However, nerve release did not provide hand muscle recovery in patients with objective N-TOS. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- C Diner
- Department of Trauma, Orthopedic and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - L Mathieu
- Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003 Lyon, France; Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 75005 Paris, France.
| | - C Vandendries
- RMX Center, 80 Avenue Felix Faure, 75015 Paris, France
| | - C Oberlin
- Nerve and Brachial Plexus Surgery Unit, Mont-Louis Private Hospital, 8 Rue de la Folie Regnault, 75011 Paris, France
| | - Z Belkheyar
- Nerve and Brachial Plexus Surgery Unit, Mont-Louis Private Hospital, 8 Rue de la Folie Regnault, 75011 Paris, France
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F. Dengler N, T. Pedro M, Kretschmer T, Heinen C, Rosahl SK, Antoniadis G. Neurogenic Thoracic Outlet Syndrome. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:735-742. [PMID: 35978467 PMCID: PMC9975980 DOI: 10.3238/arztebl.m2022.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 07/21/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Thoracic outlet syndrome (TOS) refers to a group of disorders in which there is compression of and/or damage to the neurovascular structures at the thoracic outlet, i.e., at the transition from chest to neck. The incidence of neurogenic thoracic outlet syndrome (nTOS) is estimated to be 2-3 / 100 000 / year, with an estimated prevalence of 10 / 100 000. Patients present with upper extremity sensorimotor symptoms that are often related to movement. The aim of the present article is to highlight the clinical presentation patterns of nTOS and to provide an overview of its diagnosis and treatment. METHODS Selective literature search for prospective observational studies and RCTs, including systematic reviews and metaanalyses. RESULTS There is no multicenter randomized controlled trial available on the treatment of nTOS. Prospective observational studies with a hierarchical study design report a positive effect of physiotherapy in 27-59% of cases. After unsuccessful conservative treatment, up to 56-90% benefit from surgical management. Patients with nTOS are more severely affected compared with those with other forms of TOS and benefit less from transaxillary first rib resection. nTOS patients who underwent supraclavicular decompression without rib resection had excellent surgical outcomes in 27%, good outcomes in 36%, acceptable outcomes in 26%, and poor surgical outcomes in 11% of cases. There is no systematic comparison available of the types of surgical management involved. Also, there is currently no uniform classification available for all medical sub-disciplines. Therefore, interpretation, and comparability of the study results are limited. CONCLUSION Although nTOS is the most common form of TOS, studies on its treatment are currently limited in terms of numbers and quality. The type of surgical management varies according to the experience and preference of the surgeon, treating specialty, special anatomic features, and clinical symptoms.
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Affiliation(s)
- Nora F. Dengler
- Department of Neurosurgery, Charité— Universitätsmedizin Berlin,*Charité – Universitätsmedizin Berlin Campus Benjamin Franklin Klinik für Neurochirurgie Hindenburgdamm 30, D-12203 Berlin, Germany
| | - Maria T. Pedro
- District Hospital of Günzburg, Neurosurgical Department of the University of Ulm
| | - Thomas Kretschmer
- Department of Neurosurgery and Neurorestauration, Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Christian Heinen
- Peripheral Nerve Unit Nord, Christliches Krankenhaus Quakenbrück GmbH, Quakenbrück
| | | | - Gregor Antoniadis
- District Hospital of Günzburg, Neurosurgical Department of the University of Ulm
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Fouasson-Chailloux A, Daley P, Menu P, Gadbled G, Bouju Y, Gautier G, Pomares G, Dauty M. Use of hand hydraulic dynamometers as an overall evaluation of the upper-limb weakness in patients with thoracic outlet syndrome. Front Neurol 2022; 13:919312. [PMID: 36046630 PMCID: PMC9420998 DOI: 10.3389/fneur.2022.919312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023] Open
Abstract
Patients with neurogenic thoracic outlet syndrome report pain and upper-limb weakness. They complain about weakness occurring on the entire upper-limb, especially at the hand and the shoulder levels. Hydraulic dynamometers can reliably assess the strength of the hand, and isokinetic shoulder testing can provide accurate and reliable evaluations of the rotators strength. Yet, isokinetic proximal assessment needs expensive tools, whereas hydraulic hand dynamometers are cheap and easy to use. We aimed to assess the correlation between the isokinetic shoulder strength and the hand grip and the key pinch strength. The grip strength was evaluated with a hydraulic hand dynamometer and the key pinch with a pinch gauge. Isokinetic rotators strength tests were performed using a Humac Norm® dynamometer at 60 and 180°/s. One-hundred and thirty patients had been included, 72% of women, mean age of 39.8 ± 9.5. Symptomatic hands presented a strength deficit of 12.2% on the grip (p < 0.0001) and 10% on the key pinch (p = 0.01). Isokinetic strength was lower on the symptomatic shoulders at 60 and 180°/s concerning medial rotators [−10.3 and −8.8%, respectively (p = 0.02)] and lateral rotators [−10.8 and −10%, respectively (p = 0.04 and p = 0.03)]. There was a moderate correlation between the grip strength of the symptomatic upper-limbs and the isokinetic rotators strength (p < 0.001). The key pinch strength was moderately correlated to the isokinetic medial and lateral rotators strength at 60°/s (p < 0.001). Hand dynamometers could prove useful during medical consultations or in outpatient management to assess upper-limb overall weakness, but isokinetic measurement remains the gold standard for a precise evaluation.
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Affiliation(s)
- Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- IRMS, Institut Régional de Médecine du Sport, Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, Nantes, France
- *Correspondence: Alban Fouasson-Chailloux
| | - Pauline Daley
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
| | - Pierre Menu
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- IRMS, Institut Régional de Médecine du Sport, Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, Nantes, France
| | - Guillaume Gadbled
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU Nantes, Nantes Université, Nantes, France
| | - Yves Bouju
- Institut Main Atlantique, Saint Herblain, France
| | - Giovanni Gautier
- Explorations Fonctionnelles Vasculaires, CHU Nantes, Nantes Université, Nantes, France
| | - Germain Pomares
- Institut Européen de la Main, Hopital Kirchberg, Luxembourg, Luxembourg
| | - Marc Dauty
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- IRMS, Institut Régional de Médecine du Sport, Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, Nantes, France
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Lingyun W, Ke S, Jinmin Z, Yu Q, Jun Q. Derkash's Classification and Vas Visual Analog Scale to Access the Long-Term Outcome of Neurothoracic Outlet Syndrome: A Meta-Analysis and Systematic Review. Front Neurol 2022; 13:899120. [PMID: 35873776 PMCID: PMC9296859 DOI: 10.3389/fneur.2022.899120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Many publications report outcomes of surgical treatment for neurothoracic outlet syndrome (NTOS); however, high-quality meta-analyses regarding objective evaluation system accessing the long-term outcome of NTOS are lacking. This meta-analysis summarizes and compares the outcomes of Derkosh's classification and vas visual analog scale of the supraclavicular neuroplastic of brachial plexus (SNBP) and trams auxiliary first rib resection (TFRR). Methods The Cochrane Library, PubMed, EMBASE, Allied and Complementary Medicine (AMED) were searched for papers published between January 1980 and February 2021, using the keywords “thoracic outlet syndrome,” “treatment, surgical.” Articles were eligible for inclusion if the following criteria were met studies describing outcomes of surgery for NTOS, published in English, human studies, and available in full text. The exclusion criteria were case reports (n < 10), reviews, abstracts, and studies lacking a control group or without evaluation for two types of surgery. Results We included 10 studies with 1,255 cases, out of which 622 were in the SNBP group; and 633 were in the TFRR group. After surgery (≥12 months), Derkash's classification was improved in 425 cases with SNBP and 364 cases with TFRR. OR = 1.34 (95% CI: 0.94, 1.92), P = 0.03; vas visual analog scale was improved in 282 cases in the SNBP group and 214 cases in the TFRR group. OR = 1.08 (95% CI: 0.63, 1.85), P = 0.78. Conclusion This meta-analysis shows that both SNBP and TFRR are effective for NTOS, but that SNBP is better than TFRR in improving Derkash's classification in the long term. Although patients treated with SNBP are more satisfactory, there is no significant difference in vas visual analog scale from TFRR. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021254203, PROSPERO CRD42021254203.
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Affiliation(s)
- Wei Lingyun
- Research Centre for Regenerative Medicine, Orthopaedic Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio Resource Development and Application Co-constructed by the Province and Ministry, Nanning, China
- Department of Traumatic Hand Surgery, The First Affiliated Hospital of Guilin Medical College, Guilin, China
- *Correspondence: Wei Lingyun
| | - Sha Ke
- Research Centre for Regenerative Medicine, Orthopaedic Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio Resource Development and Application Co-constructed by the Province and Ministry, Nanning, China
| | - Zhao Jinmin
- Research Centre for Regenerative Medicine, Orthopaedic Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio Resource Development and Application Co-constructed by the Province and Ministry, Nanning, China
- Zhao Jinmin
| | - Qiao Yu
- Research Centre for Regenerative Medicine, Orthopaedic Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio Resource Development and Application Co-constructed by the Province and Ministry, Nanning, China
| | - Qin Jun
- Research Centre for Regenerative Medicine, Orthopaedic Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bio Resource Development and Application Co-constructed by the Province and Ministry, Nanning, China
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Daley P, Pomares G, Menu P, Gadbled G, Dauty M, Fouasson-Chailloux A. Shoulder Isokinetic Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11091529. [PMID: 34573871 PMCID: PMC8465876 DOI: 10.3390/diagnostics11091529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Neurogenic thoracic outlet syndrome (NTOS) is an impairing painful condition. Patients usually report upper-limb pain, weakness and paresthesia. Shoulder weakness is frequently reported but has never been described with objective strength evaluation. We aimed to compare isokinetic shoulder strength between patients with NTOS and healthy controls. Patients and controls were prospectively evaluated with an isokinetic strength test at 60 and 180°/s, and an endurance test (30 repetitions at 180°/s) of the shoulder rotators. Patients were functionally assessed with QuickDASH questionnaires. One hundred patients and one hundred healthy subjects were included. Seventy-one percent of patients with NTOS were females with a mean age of 39.4 ± 9.6. They were compared to controls, 73% females and the mean age of 38.8 ± 9.8. Patients' mean QuickDASH was 58.3 ± 13.9. Concerning the peak of strength at 60°/s, the symptomatic limbs of patients with NTOS had significantly 21% and 29% less strength than the control limbs for medial and lateral rotators, respectively (p ≤ 0.001). At 180°/s, the symptomatic limbs had significantly 23% and 20% less strength than the controls for medial and lateral rotators, respectively (p ≤ 0.001). The symptomatic limbs had significantly 45% and 30% less endurance than the controls for medial and lateral rotators, respectively (p ≤ 0.001). These deficits were correlated to the QuickDASH. Patients with NTOS presented a significant deficit of strength and endurance of the shoulder rotators correlated to disability. This highlights the interest in upper-limb strength evaluation in the diagnostic process and the follow-up of NTOS.
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Affiliation(s)
- Pauline Daley
- CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
| | - Germain Pomares
- Institut Européen de la Main, 2540 Luxembourg, Luxembourg;
- Medical Training Center, Hopital Kirchberg, 2540 Luxembourg, Luxembourg
| | - Pierre Menu
- CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, 44042 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
| | - Guillaume Gadbled
- CHU Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, 44093 Nantes, France;
| | - Marc Dauty
- CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, 44042 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
| | - Alban Fouasson-Chailloux
- CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, 44042 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Correspondence: ; Tel.: +33-240-846-211
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Fouasson-Chailloux A, Daley P, Menu P, Louguet B, Gadbled G, Bouju Y, Abraham P, Dauty M. Hand Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11050874. [PMID: 34068245 PMCID: PMC8153137 DOI: 10.3390/diagnostics11050874] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022] Open
Abstract
Neurogenic thoracic outlet syndrome (NTOS) is a chronic painful and disabling condition. Patients complain about upper-limb paresthesia or weakness. Weakness has been considered one of the diagnostic criteria of NTOS, but objective comparisons to healthy controls are lacking. We compared the grip and the key pinch strengths between NTOS patients and healthy controls. Grip strength was evaluated with a hydraulic hand dynamometer and the key pinch with a pinch gauge. All the patients with NTOS completed a QuickDASH. We included prospectively 85 patients with NTOS, 73% female and 27% male. The mean age was 40.4 ± 9.6. They were compared to 85 healthy subjects, 77.6% female and 22.4% male. Concerning the grip, symptomatic hands of NTOS patients had significantly 30% less strength compared to control hands (p ≤ 0.001), and 19% less strength compared to asymptomatic hands (p = 0.03). Concerning the key pinch, symptomatic hands of patients with NTOS had significantly 19.5% less strength compared to control hands (p ≤ 0.001). Grip and key pinch strengths had a significant correlation with the QuickDASH (r = −0.515 and r = −0.403, respectively; p ≤ 0.001). Patients with NTOS presented an objective hand strength deficit compared to healthy controls. This deficit was significantly correlated to the upper-limb disability. These findings confirm the interest of hand strength evaluation in the diagnostic process of patients with NTOS.
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Affiliation(s)
- Alban Fouasson-Chailloux
- CHU Nantes, Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, F-44042 Nantes, France
- Correspondence: ; Tel.: +33-240-846-211
| | - Pauline Daley
- CHU Nantes, Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France;
| | - Pierre Menu
- CHU Nantes, Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, F-44042 Nantes, France
| | - Bastien Louguet
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
| | - Guillaume Gadbled
- CHU Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, 44093 Nantes, France;
| | - Yves Bouju
- Institut Main Atlantique, 44800 Saint Herblain, France;
| | - Pierre Abraham
- Sports Medicine Department, University Hospital of Angers, 49100 Angers, France;
- Vascular Medicine Department, University Hospital of Angers, 49100 Angers, France
- Mitovasc, UMR CNRS 6015 INSERM 1083, LUNAM University, 49100 Angers, France
| | - Marc Dauty
- CHU Nantes, Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, F-44042 Nantes, France
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