Skip to main content

Neurological Thoracic Outlet Syndrome: Approaching a Pathognomonic Sign

  • Chapter
  • First Online:
Functional Electromyography

Abstract

It is ironic that in substantiating a diagnosis of exclusion such as thoracic outlet syndrome, it is critical to exclude an especially wide variety of other diagnoses. We first pare off vascular thoracic outlet syndrome, and make many exclusionary provisions before confirming that a functional electrodiagnostic test is positive with a fair-sized group of qualifying patients with impressive pain that bears no other ready explanation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wilbourne, AJ, Lederman, RJ. “Evidence for conduction delay in thoracic-outlet syndrome is challenged.” N Engl J Med. 1996;310:1052.

    Google Scholar 

  2. Smith, T, Trojaborg, W. “Diagnosis of thoracic outlet syndrome. Value of sensory and motor conduction studies and quantitative electromyography.” Arch Neurol. 1987;44:1161.

    Article  PubMed  CAS  Google Scholar 

  3. Peet, RM, Hendrickson, JD, Gunderson, TP, Martin, GM. “Thoracic outlet syndrome: evaluation of a therapeutic exercise program.” Proc Mayo Clin. 1956;31:265.

    Google Scholar 

  4. Rayan, GM, Jensen, C. “Thoracic outlet syndrome: provocative examination maneuvers in a typical population.” J Shoulder Elbow Surg. 1995 Mar–Apr;4(2):113–17.

    Google Scholar 

  5. Travell, JG, Simons, DG. Myofascial Pain and Dysfunction the Trigger Point Manual Volume 1. Williams and Wilkins, Baltimore, 1983, p. 357.

    Google Scholar 

  6. Dawson, DM, Hallett, M, Millender, LH. Entrapment Neuropathies. 2nd Ed. Little Brown and Company, Boston/Toronto, 1990.

    Google Scholar 

  7. Plewa, MC, Delinger, M. “The false-positive rate of thoracic outlet syndrome shoulder maneuvers in healthy subjects.” Acad Emerg Med. 1998 Apr;5(4):337–42.

    Google Scholar 

  8. Nord, KM, Kapoor, P, Fisher, J, Thomas, G, Sundaram, A, Scott, K, Kothari, MJ. “False positive rate of thoracic outlet syndrome diagnostic maneuvers.” Electromyogr Clin Neurophysiol. 2008 Mar;48(2):67–74.

    Google Scholar 

  9. Sanders, RJ, Hammond, SL, Rao, NM. ”Diagnosis of thoracic outlet syndrome.” J Vasc Surg. 2007 Sep;46(3):601–4.

    Google Scholar 

  10. Ghoussoub, K, Tabet, G, Faraj, C, Sleilaty, G, Roukoz, S, Jebara, V. “Predictive factors of long-term functional rehabilitation in thoracic outlet syndromes: 85 patients.” Ann Readapt Med Phys. Epub 2006 Apr;50(3):134–9, Dec 22. [Article in French].

    Google Scholar 

  11. Hood, DB, Kuehne, J, Yellin, AE, Weaver, FA. “Vascular complications of thoracic outlet syndrome.” Am Surg. 1997 Oct;63(10):913–17.

    Google Scholar 

  12. Mayfield, FH. “Neural and vascular compression syndromes of the shoulder girdle and arms.” In Vinken, PJ, Bruyn, GW (eds.). Textbook of Clinical Neurology. Vol. 7. American Elsevier, New York, 1976.

    Google Scholar 

  13. Hamlin, H, Pecora, D. “Subclavian segmental resection of the first rib for correction of subjacent neurovascular compression.” Am J Surg. 1969;117:754.

    Article  PubMed  CAS  Google Scholar 

  14. Adson, AW. “Cervical ribs: Symptoms, differential diagnosis and indications for section of the insertion of the scalenus anticus muscle.” J Int College Surg. 1951;16:546–59.

    CAS  Google Scholar 

  15. Roos, DB. “Congenital anomalies associated with thoracic outlet syndrome.” Am J Surg. 1976;132:771.

    Article  PubMed  CAS  Google Scholar 

  16. Naffziger, HC, Brant, WT. “Neuritis of the brachial plexus mechanical in origin. The scalenus syndrome.” Surgic Gynecol Obstet. 1938;67:722–30.

    Google Scholar 

  17. Ger, R, Abrams, P, Olson, TR. Essentials of Clinical Anatomy. 2nd Ed. Parthenon, New York and London, 2001, pp. 248–9.

    Google Scholar 

  18. Lon, C. “Myofascial pain syndromes: part 2- syndromes of the head, neck and shoulder girdle.” Henry Ford Hospital Med Bull. 1956;4:22–8, Quoted in Travell, JG, Simons, DG. Myofascial Pain and Dysfunction the Trigger Point Manual Volume 1. Williams and Wilkins, Baltimore, 1983.

    Google Scholar 

  19. Frankel, SA, Hirata, I, Jr. “The scalenus anticus syndrome and competitive swimming.” JAMA. 1971;215:1796–8.

    Article  PubMed  CAS  Google Scholar 

  20. Wilbourn, JA, Porter, JA. “Thoracic outlet syndrome.” Spine. 1988;2:57.

    Google Scholar 

  21. Grant, JCB. An Atlas of Human Anatomy. 7th Ed. Williams and Wilkins, Baltimore, 1978, Figs. 9-46 and 9-83.

    Google Scholar 

  22. Franklin, GM, Fulton-Kehoe, D, Bradley, C, Smith-Weller, T. “Outcome of surgery for thoracic outlet syndrome in Washington state workers' compensation.” Neurology. 2000 Nov 28;55(10):1594–5.

    Google Scholar 

  23. Ersche, HC, Razzuk, MA. “Management of the thoracic outlet syndrome.” N Engl J Med. 1972;286:1140.

    Article  Google Scholar 

  24. Han, S, Yildirim, E, Dural, K, Ozisik, K, Yazkan, R, Sakinci, U. “Transaxillary approach in thoracic outlet syndrome: the importance of resection of the first-rib.” Eur J Cardiothoracic Surg. 2003 Sep;24(3):428–33.

    Google Scholar 

  25. Yainnikas, C. In Chiappa, KH Evoked Potentias in Clinical Medicine. Raven Press, New York, 1989, pp. 278–280.

    Google Scholar 

  26. Sunderland, D. Nerves and Nerve Injuries. 2nd Ed. Churchill Livingstone, London, 1978.

    Google Scholar 

  27. Cherington, M, Happer, I, Mechanic, B, Parry, L. “Surgery for thoracic outlet syndrome may be hazardous to your health.” Muscle Nerve 1986;9:632–4.

    Article  PubMed  CAS  Google Scholar 

  28. Bhattacharya, V, Hansrani, M, Wyat, MG, Lambert, D, Jones, NAG. “Outcome following Surgery for Thoracic Outlet Syndrome.” Eur J Vasc Endovasc Surg. 2003 Aug;26(Issue 2):170–5.

    Google Scholar 

  29. Oates, SD, Daley, RA. “Thoracic outlet syndrome.” Hand Clin. 1996 Nov;12(4):705–18.

    Google Scholar 

  30. Kline, DG, Judice, DJ. “Operative management of selected brachial plexus lesions.” J Neurosurg. 1983;58:631–49.

    Article  PubMed  CAS  Google Scholar 

  31. Adson, AW. “Cervical ribs: the symptoms, differential diagnosis and indications for section of the insertions of.” J Int College Surg. 1951 Nov;15(5):546–59.

    Google Scholar 

  32. Delisa, JA, Mackenzie, L, Baran, EM. Manual of Nerve Conduction Velocity and Somatosensory Evoked Potentials. 2nd Ed. Raven Press, New York, 1987.

    Google Scholar 

  33. Kimura, J. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 2nd Ed. F.A. Davis and Co., Philadelphia, 1999.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Loren M. Fishman MD .

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Fishman, L.M., Wilkins, A.N. (2011). Neurological Thoracic Outlet Syndrome: Approaching a Pathognomonic Sign. In: Functional Electromyography. Springer, Boston, MA. https://doi.org/10.1007/978-1-60761-020-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-020-5_4

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-60761-019-9

  • Online ISBN: 978-1-60761-020-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics