Thoracic outlet syndrome

A risk factor is defined as an attribute or exposure that increases the probability of a disease or disorder (Putz-Anderson, 1988). Biomechanical risk factors for musculoskeletal disorders include repetitive and sustained exertions, awkward postures, and application of high mechanical forces. Vibration and cold environments may also accelerate the development of musculoskeletal disorders. Typical tools that can be used to identify the potential for development of musculoskeletal disorders include conducting work-methods analyses and checklists designed to itemize undesirable work site conditions or worker activities that contribute to injury. Since most of manual work requires the active use of the arms and hands, the structures of the upper extremities are particularly vulnerable to soft tissue injury. WUEDs are typically associated with repetitive manual tasks with forceful exertions, such as those performed at assembly lines, or when using hand tools, computer keyboards and other devices, or operating machinery. These tasks impose repeated stresses to the upper body, that is, the muscles, tendons, ligaments, nerve tissues, and neurovascular structures. There are three basic types of WRDs to the upper extremity tendon disorder (such as tendonitis), nerve disorder (such as carpal tunnel syndrome), and neurovascular disorder (such as thoracic outlet syndrome or vibration-Raynaud s syndrome). The main biomechanical risk factors of musculoskeletal disorders are presented in Table 22. 

Thoracic outlet syndrome A disorder resulting from compression of nerves and blood vessels between the clavicle and the first and second ribs at the brachial plexus. 

A musculoskeletal injury that arises gradually as a result of repeated microtrauma. CTDs are characterized by injuries to the tendons, nerves, or neurovascular system. Muscles and joints are stressed, tendons are inflamed, nerves are pinched, or the flow of blood is restricted. Examples of CTDs include tendinitis, tenosynovitis, carpal tunnel syndrome, thoracic outlet syndrome, and Raynaud s phenomenon (white finger disease). 

Fig. 24.16a,b. Bilateral thoracic outlet syndrome explored with CT imaging with the arms alongside the body (a) and after elevation of the arms (b). Compression of the subclavian artery in the entrance of the costoclavicular space (arrows) is well demonstrated after elevation of the arms... 

Remy-Jardin M, Remy J, Masson P et al (2000) CT angiography of thoracic outlet syndrome evaluation of imaging protocols for the detection of arterial stenosis. J Comput Assist Tomogr 24 349-361... 

Harding A, Silver D. Thoracic outlet syndrome. In Sabistan, Textbook of Surgery, 14th ed. Townsend CM, ed. Philadelphia W.B. Saunders, 1991, pp. 1757-1761. 

Parachuri R, Adaues EM. Entrapment neuropathies. Postgrad Med 1993 94 39-51. (Thoracic outlet syndrome in p. 45.)... 

The Musculoskeletal disorders more commonly seen in dental surgeons are Carpal Tunnel Syndrome Ulnar Nerve Entrapment Pronator Syndrome Tendinitis Tenosynovitis Extensor Wad Strain Thoracic Outlet Syndrome Rotator Cuff Tendonitis (Nield-Gehrig, 2008). 

The lirst rib is probably the rib most commonly involved in somatic dysfunction of all the ribs. It is affected by trauma, stress, and posture as well as by dysfunction ofthe C7-T1 complex. The patient may report "shoulder" pain, stiff neck, upper back or neck pain, and an inability to turn the head while driving. The first rib can impinge the neurovascular bundle as it passes between it and the clavicle through the costoclavicular space. The anterior and middle scalene muscles, which raise the first rib, may likewise compress the brachial plexus when they are in spasm and result in thoracic outlet syndrome symptoms. The patient s symptoms are then described as pain, numbness, or paresthesias ofthe arm or hand on the involved side. The physician needs to be aware that this may cause confusion should the patient demonstrate a herniated cervical disc on magnetic resonance imaging [MRO. The symptoms may be caused by the rib dysfunction rather than the herniated disc, so evaluation ofthe rib for normal motion and treatment of any dysfunction should be performed in these cases. Osteopathic manipulation may save the patient unnecessary surgery. 

Thoracic outlet syndrome is a range of disorders arising from the passage of the subclavian artery and... 

Lombardi T, Sherman L, van Holsbeeck MT (1992) Sonographic detection of septic subdeltoid bursitis a case report. J Ultrasound Med 11 159-160 Longley DG, Yedlicka JW, Molina EJ et al (1992) Thoracic outlet syndrome evaluation of the subclavian vessels by color duplex sonography. AJR Am J Roentgenol 158 623-630... 

Rockwood CA Jr (1984) Injuries to the acromioclavicular joint. In Rockwood CA, Greene DP (eds) Fractures in adults, 2nd edn, vol 1. JB Lippincott, Philadelphia, pp 860-910 Roos DB (1976) Congenital anomalies associated with thoracic outlet syndrome. Am J Surg 132 771-778 Ross GJ, Love MB (1989) Isolated avulsion fracture of the lesser tuberosity of the humerus report of two cases. Radiology 172 833-834... 

Poor workplace design can injure the arms and shoulders of warehouse workers. Tasks that require employees to work with their arms outstretched or their elbows up may result in fatigue of the muscles in the arms and shoulders. There may be pain and injury caused by compression and entrapment of the nerves that run through the shoulder, similar to carpal tunnel syndrome of the wrist. The entrapment of the nerves in the shoulder is a condition known as thoracic outlet syndrome. 

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