Advertisement

Der Chirurg

, Volume 80, Issue 1, pp 65–76 | Cite as

Thoracic-outlet-Syndrom

Differenzialdiagnose und chirurgische Therapieoptionen
  • A. Dragu
  • W. Lang
  • F. Unglaub
  • R.E. Horch
CME Weiterbildung • Zertifizierte Fortbildung

Zusammenfassung

Das Thoracic-outlet-Syndrom (TOS) ist ein häufig kontrovers diskutiertes Syndrom im Bereich der Kompressionssyndrome an der oberen Extremität. Dies ist jedoch nicht verwunderlich, da das TOS vielschichtige Ursachen aufweist und zudem nicht nur einer Fachdisziplin zuzuordnen ist. So benötigten nach einer Untersuchung im Durchschnitt 6,5 Ärzte verschiedener Fachrichtungen etwa 4,3 Jahre zur Diagnose. Eine erfolgreiche operative Behandlung eines Patienten mit TOS bedarf immer einer extrem sorgfältigen Erhebung der individuellen und meist komplexen Anamnese mit anschließender körperlicher Untersuchung und einer ausführlichen Diagnostik. Diese notwendige Diagnostik ist nur im Team und v. a. interdisziplinär zu erreichen. Dazu zählen ausdrücklich nicht nur die ärztlichen Disziplinen, sondern insbesondere auch die Physiotherapie. Im vorliegenden Beitrag werden die Vorgehensweisen und Zusammenhänge zur erfolgreichen Diagnose und Behandlung des TOS aufgezeigt und zusammengefasst.

Schlüsselwörter

Thoracic-outlet-Syndrom Kompressionssyndrom Obere Extremität Chronisches Schmerzsyndrom 

Thoracic outlet syndrome

Differential diagnosis and surgical therapeutic options

Abstract

The thoracic outlet syndrome (TOS) is a disputed syndrome in the field of the so-called compression syndromes of the upper extremity. This is no surprise, as the TOS is a complex and multifactorial compression syndrome diagnosed by different medical specialities. On average 6.5 physicians of different specialities need 4.3 years to come up with the diagnosis of TOS. The correct diagnosis is of great importance and crucial for successful operative treatment. The necessary diagnostic tests can only be accomplished by team work, especially interdisciplinary cooperation. This expressly includes physiotherapy and not just the medical disciplines. This contribution presents a summary of the approaches and interactions involved in effective diagnosis and treatment of TOS.

Keywords

Thoracic outlet syndrome Compression syndrome Superior extremity Chronic pain syndrome 

Notes

Danksagung

Die Abbildungen 1a, 2 und 3 wurden durch die Graphikabteilung (Leiter: Herr Gerd Leiser) der chirurgischen Klinik des Universitätsklinikums Erlangen-Nürnberg erstellt.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Abdellaoui A, Atwan M, Reid F et al. (2007) Endoscopic assisted transaxillary first rib resection. Interact Cardiovasc Thorac Surg 6: 644–646PubMedCrossRefGoogle Scholar
  2. 2.
    Altobelli GG, Kudo T, Haas BT et al. (2005) Thoracic outlet syndrome: pattern of clinical success after operative decompression. J Vasc Surg 42: 122–128PubMedCrossRefGoogle Scholar
  3. 3.
    Ambrad-Chalela E, Thomas GI, Johansen KH (2004) Recurrent neurogenic thoracic outlet syndrome. Am J Surg 187: 505–510PubMedCrossRefGoogle Scholar
  4. 4.
    Arkudas A, Kneser U, Horch RE (2006) Complex regional pain syndrome type I (CRPS type I/“RSD“) - an overview. Zentralbl Chir 131:W40-8; quiz W49-50PubMedCrossRefGoogle Scholar
  5. 5.
    Atasoy E (2004) Recurrent thoracic outlet syndrome. Hand Clin 20: 99–105PubMedCrossRefGoogle Scholar
  6. 6.
    Axelrod DA, Proctor MC, Geisser ME et al. (2001) Outcomes after surgery for thoracic outlet syndrome. J Vasc Surg 33: 1220–1225PubMedCrossRefGoogle Scholar
  7. 7.
    Bach AD, Arkudas A, Tjiawi J et al. (2006) A new approach to tissue engineering of vascularized skeletal muscle. J Cell Mol Med 10: 716–726PubMedCrossRefGoogle Scholar
  8. 8.
    Bahm J (2006) Systematic and critical consideration of the thoracic outlet syndrome: clinical picture and therapy. Handchir Mikrochir Plast Chir 38: 56–63PubMedCrossRefGoogle Scholar
  9. 9.
    Balci AE, Balci TA, Cakir O et al. (2003) Surgical treatment of thoracic outlet syndrome: effect and results of surgery. Ann Thorac Surg 75: 1091–1096PubMedCrossRefGoogle Scholar
  10. 10.
    Barkhordarian S (2007) First rib resection in thoracic outlet syndrome. J Hand Surg Am 32: 565–570PubMedCrossRefGoogle Scholar
  11. 11.
    Bhattacharya V, Hansrani M, Wyatt MG et al. (2003) Outcome following surgery for thoracic outlet syndrome. Eur J Vasc Endovasc Surg 26: 170–175PubMedCrossRefGoogle Scholar
  12. 12.
    Bilbey JH, Muller NL, Connell DG et al. (1989) Thoracic outlet syndrome: evaluation with CT. Radiology 171: 381–384PubMedGoogle Scholar
  13. 13.
    Bleiziffer O, Eriksson E, Yao F et al. (2007) Gene transfer strategies in tissue engineering. J Cell Mol Med 11: 206–223PubMedCrossRefGoogle Scholar
  14. 14.
    Brantigan CO, Johnston RJ, Roos DB (2004) Appendix: use of multidetector CT and three-dimensional reconstructions in thoracic outlet syndrome: a preliminary report. Hand Clin 20: 123–126 viiiPubMedCrossRefGoogle Scholar
  15. 15.
    Busetto A, Fontana P, Zaccaria A et al. (2005) Vascular thoracic outlet syndrome staging and treatment. Acta Neurochir Suppl 92: 29–31PubMedGoogle Scholar
  16. 16.
    Chang DC, Lidor AO, Matsen SL et al. (2007) Reported in-hospital complications following rib resections for neurogenic thoracic outlet syndrome. Ann Vasc Surg 21: 564–570PubMedCrossRefGoogle Scholar
  17. 17.
    Crotti FM, Carai A, Carai M et al. (2005) TOS pathophysiology and clinical features. Acta Neurochir Suppl 92: 7–12PubMedCrossRefGoogle Scholar
  18. 18.
    Demirbag D, Unlu E, Ozdemir F et al. (2007) The relationship between magnetic resonance imaging findings and postural maneuver and physical examination tests in patients with thoracic outlet syndrome: results of a double-blind, controlled study. Arch Phys Med Rehabil 88: 844–851PubMedCrossRefGoogle Scholar
  19. 19.
    Demondion X, Vidal C, Herbinet P et al. (2006) Ultrasonographic assessment of arterial cross-sectional area in the thoracic outlet on postural maneuvers measured with power Doppler ultrasonography in both asymptomatic and symptomatic populations. J Ultrasound Med 25: 217–224PubMedGoogle Scholar
  20. 20.
    Denzel C, Lang W (2008) Critical limb ischemia. Chirurg 79: 495–508PubMedCrossRefGoogle Scholar
  21. 21.
    Fiegel HC, Kaufmann PM, Bruns H et al. (2008) Hepatic tissue engineering: from transplantation to customized cell-based liver directed therapies from the laboratory. J Cell Mol Med 12: 56–66PubMedCrossRefGoogle Scholar
  22. 22.
    Gomez E, Bastida R, Oleaga L et al. (2006) Diagnosis of thoracic outlet syndrome by angio-MRI. Radiologia 48: 295–300PubMedCrossRefGoogle Scholar
  23. 23.
    Gruss JD, Geissler C (1997) Über das Thoracic outlet Syndrom. Gefässchirurgie 2: 57–64CrossRefGoogle Scholar
  24. 24.
    Guillot PV, Cui W, Fisk NM et al. (2007) Stem cell differentiation and expansion for clinical applications of tissue engineering. J Cell Mol Med 11: 935–944PubMedCrossRefGoogle Scholar
  25. 25.
    Hempel GK, Shutze WP, Anderson JF et al. (1996) 770 consecutive supraclavicular first rib resections for thoracic outlet syndrome. Ann Vasc Surg 10: 456–463PubMedCrossRefGoogle Scholar
  26. 26.
    Horch RE, Nord D, Augustin M et al. (2008) Economic aspects of surgical wound therapies. ChirurgGoogle Scholar
  27. 27.
    Horch RE, Unglaub F, Dragu A et al. (2008) Kienbock’s disease: diagnosis and therapy. Chirurg 79: 452–460PubMedCrossRefGoogle Scholar
  28. 28.
    Huang JH, Zager EL (2004) Thoracic outlet syndrome. Neurosurgery 55: 897–902PubMedCrossRefGoogle Scholar
  29. 29.
    Hutmacher DW, Cool S (2007) Concepts of scaffold-based tissue engineering–the rationale to use solid free–form fabrication techniques. J Cell Mol Med 11: 654–669PubMedCrossRefGoogle Scholar
  30. 30.
    Jamieson WG, Chinnick B (1996) Thoracic outlet syndrome: fact or fancy? A review of 409 consecutive patients who underwent operation. Can J Surg 39: 321–326PubMedGoogle Scholar
  31. 31.
    Jordan SE, Ahn SS, Freischlag JA et al. (2000) Selective botulinum chemodenervation of the scalene muscles for treatment of neurogenic thoracic outlet syndrome. Ann Vasc Surg 14: 365–369PubMedCrossRefGoogle Scholar
  32. 32.
    Jordan SE, Ahn SS, Gelabert HA (2007) Differentiation of thoracic outlet syndrome from treatment-resistant cervical brachial pain syndromes: development and utilization of a questionnaire, clinical examination and ultrasound evaluation. Pain Physician 10: 441–452PubMedGoogle Scholar
  33. 33.
    Kalkanis SN, Eskandar EN, Carter BS et al. (2003) Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 52: 1251–1261PubMedCrossRefGoogle Scholar
  34. 34.
    Kneser U, Stangenberg L, Ohnolz J et al. (2006) Evaluation of processed bovine cancellous bone matrix seeded with syngenic osteoblasts in a critical size calvarial defect rat model. J Cell Mol Med 10: 695–707PubMedCrossRefGoogle Scholar
  35. 35.
    Koknel Talu G (2005) Thoracic outlet syndrome. Agri 17: 5–9Google Scholar
  36. 36.
    Konig RW, Kretschmer T, Borm W et al. (2005) Neurogenic thoracic outlet syndrome. Long-term results of supraclavicular decompression. Nervenarzt 76: 1222, 1224–1246, 1230PubMedCrossRefGoogle Scholar
  37. 37.
    Krishnan KG, Pinzer T, Schackert G (2005) The transaxillary approach in the treatment of thoracic outlet syndrome: a neurosurgical appraisal. Zentralbl Neurochir 66: 180–189PubMedCrossRefGoogle Scholar
  38. 38.
    Kunkel JM, Machleder HI. (1989) Treatment of Paget-Schroetter syndrome. A staged, multidisciplinary approach. Arch Surg 124: 1153–1157PubMedGoogle Scholar
  39. 39.
    Lee AD, Agarwal S, Sadhu D (2006) Doppler Adson’s test: predictor of outcome of surgery in non-specific thoracic outlet syndrome. World J Surg 30: 291–292PubMedCrossRefGoogle Scholar
  40. 40.
    Luther B (2006) Kompressionssyndrome der oberen Thoraxapertur. In: Hepp W, Kogel H (Hrgs) Gefäßchirurgie, 2. Aufl. Urban & Fischer, München JenaGoogle Scholar
  41. 41.
    Malas FU, Ozcakar L, Kaymak B et al. (2007) Etiological factors in thoracic outlet syndrome. Orthopedics 30: 425PubMedGoogle Scholar
  42. 42.
    McSweeney SE, Al-Kelani R, Harte P et al. (2005) Thoracic outlet syndrome secondary to first rib anomaly: the value of multi-slice CT in diagnosis and surgical planning. Ir Med J 98: 246–247PubMedGoogle Scholar
  43. 43.
    Mingoli A, Feldhaus RJ, Farina C et al. (1995) Long-term outcome after transaxillary approach for thoracic outlet syndrome. Surgery 118: 840–844PubMedCrossRefGoogle Scholar
  44. 44.
    Mullins GM, O’Sullivan SS, Neligan A et al. (2007) Non-traumatic brachial plexopathies, clinical, radiological and neurophysiological findings from a tertiary centre. Clin Neurol Neurosurg 109: 661–666PubMedCrossRefGoogle Scholar
  45. 45.
    Naarden AL (2007) Thoracic outlet syndrome: a 50-year experience. Proc (Bayl Univ Med Cent) 20: 256Google Scholar
  46. 46.
    Novak CB (2003) Thoracic outlet syndrome. Clin Plast Surg 30: 175–188PubMedCrossRefGoogle Scholar
  47. 47.
    Okamoto H, Kawai K, Hattori S et al. (2005) Thoracic outlet syndrome combined with carpal tunnel syndrome and Guyon canal syndrome in a child. J Orthop Sci 10: 634–640PubMedCrossRefGoogle Scholar
  48. 48.
    Peet RM, Henriksen JD, Anderson TP et al. (1956) Thoracic-outlet syndrome: evaluation of a therapeutic exercise program. Proc Staff Meet Mayo Clin 31: 281–287PubMedGoogle Scholar
  49. 49.
    Plewa MC, Delinger M (1998) The false-positive rate of thoracic outlet syndrome shoulder maneuvers in healthy subjects. Acad Emerg Med 5: 337–342PubMedCrossRefGoogle Scholar
  50. 50.
    Polykandriotis E, Arkudas A, Horch RE et al. (2007) Autonomously vascularized cellular constructs in tissue engineering: opening a new perspective for biomedical science. J Cell Mol Med 11: 6–20PubMedCrossRefGoogle Scholar
  51. 51.
    Polykandriotis E, Premm W, Horch RE (2007) Carpal tunnel syndrome in young adults–an ultrasonographic and neurophysiological study. Minim Invasive Neurosurg 50: 328–334PubMedCrossRefGoogle Scholar
  52. 52.
    Rodriguez JM (2005) Thoracic outlet syndrome]. Rev Port Cir Cardiotorac Vasc 12: 175–184PubMedGoogle Scholar
  53. 53.
    Roos DB (1999) Thoracic outlet syndrome is underdiagnosed. Muscle Nerve 22: 126–129PubMedCrossRefGoogle Scholar
  54. 54.
    Sanders RJ, Hammond SL (2002) Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome. J Vasc Surg 36: 51–56PubMedCrossRefGoogle Scholar
  55. 55.
    Seror P (2005) Symptoms of thoracic outlet syndrome in women with carpal tunnel syndrome. Clin Neurophysiol 116: 2324–2329PubMedCrossRefGoogle Scholar
  56. 56.
    Seyhan H, Hamzavi J, Wiercinska E et al. (2006) Liver fibrogenesis due to cholestasis is associated with increased Smad7 expression and Smad3 signaling. J Cell Mol Med 10: 922–932PubMedCrossRefGoogle Scholar
  57. 57.
    Toso C, Robert J, Berney T et al. (1999) Thoracic outlet syndrome: influence of personal history and surgical technique on long-term results. Eur J Cardiothorac Surg 16: 44–47PubMedCrossRefGoogle Scholar
  58. 58.
    Urschel HC, Kourlis H (2007) Thoracic outlet syndrome: a 50-year experience at Baylor University Medical Center. Proc (Bayl Univ Med Cent) 20: 125–135Google Scholar
  59. 59.
    Wilbourn AJ (1988) Thoracic outlet syndrome surgery causing severe brachial plexopathy. Muscle Nerve 11: 66–74PubMedCrossRefGoogle Scholar
  60. 60.
    Wright D, Jennings PR (2005) Thoracic outlet syndrome. Jaapa 18: 57–58PubMedGoogle Scholar
  61. 61.
    Yavuzer S, Atinkaya C, Tokat O (2004) Clinical predictors of surgical outcome in patients with thoracic outlet syndrome operated on via transaxillary approach. Eur J Cardiothorac Surg 25: 173–178PubMedCrossRefGoogle Scholar
  62. 62.
    Zhang WJ, Liu W, Cui L et al. (2007) Tissue engineering of blood vessel. J Cell Mol Med 11: 945–957PubMedCrossRefGoogle Scholar
  63. 63.
    Prescher A, Schuster D (2006) Anatomy of the lateral cervical region with emphasis on thoracic outlet syndrome. Handchir Mikrochir Plast Chir 38: 6–13PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Klinik für Plastische und HandchirurgieUniversitätsklinikum Erlangen - NürnbergErlangenDeutschland
  2. 2.Gefäßchirurgische AbteilungUniversitätsklinikum Erlangen - NürnbergErlangenDeutschland

Personalised recommendations