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Thoracic-outlet-Syndrom

Differenzialdiagnose und chirurgische Therapieoptionen

Thoracic outlet syndrome

Differential diagnosis and surgical therapeutic options

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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.

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.

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Danksagung

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

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Authors and Affiliations

  1. Klinik für Plastische und Handchirurgie, Universitätsklinikum Erlangen - Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Deutschland

    A. Dragu, F. Unglaub &  R.E. Horch

  2. Gefäßchirurgische Abteilung, Universitätsklinikum Erlangen - Nürnberg, Erlangen, Deutschland

    W. Lang

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  1. A. Dragu
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  2. W. Lang
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  4. R.E. Horch
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Correspondence to R.E. Horch.

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Dragu, A., Lang, W., Unglaub, F. et al. Thoracic-outlet-Syndrom. Chirurg 80, 65–76 (2009). https://doi.org/10.1007/s00104-008-1609-4

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