41. CWCE MAGAZINE FOR WORKPLACE PROFESSIONALS - THORACIC OUTLET SYNDROME (TOS) thoracic outlet syndrome (TOS). Steven Feinberg, MD. CWCE July 1995.INTRODUCTION. The diagnosis and treatment of thoracic outlet syndrome http://www.cwce.com/feinbergarticles/thoracic.htm

THORACIC OUTLET SYNDROME (TOS) Steven Feinberg, MD CWCE July 1995 INTRODUCTION The diagnosis and treatment of thoracic outlet syndrome (TOS) has evolved over many years surrounded by controversy and disagreement. In fact, even the existence of this syndrome as a true clinical entity has been questioned. The weight of clinical and scientific evidence though does suggest that certain individuals have symptoms and signs compatible with the diagnosis of thoracic outlet syndrome. In the great majority of these patients, a successful outcome can be achieved with a careful diagnostic workup and a conservative rehabilitation approach. Thoracic outlet syndrome is a term describing compression of the nerves (brachial plexus) and/or the vessels (subclavian artery and vein) to the upper limb. This compression occurs in the region (thoracic outlet) between the neck and the shoulder. The thoracic outlet is bounded by several structures: the anterior and middle scalene muscles, the first rib, the clavicle, and, at a lower point, by the tendon of the pectoralis minor muscle. The brachial plexus is a branching group of nerves that form from the nerve roots as they leave the spinal cord in the region of the cervical spine (neck). The brachial plexus passes anteriorly and downward, passing behind and underneath the clavicle (collar bone) where it branches into the peripheral nerves which course below and in front of the shoulder, and then down the arm to provide motor (strength) and sensory (feeling) function to the upper extremity.

42. AAEM - Patient Resources - Thoracic Outlet Syndrome Patient Resources thoracic outlet syndrome. thoracic outlet syndrome. The thoracicoutlet is located between the base of the neck and the axilla (armpit). http://www.aaem.net/aaem/patientInfo/thoracic_outlet_syndrome.cfm

Patient Resources - Thoracic Outlet Syndrome Membership Directory Practice Issues / Advocacy Employment/Training Career Center Fellowship Listing EDX Courses Training Links ... List Rental Thoracic Outlet Syndrome The thoracic outlet is located between the base of the neck and the axilla (armpit). Many major arteries, veins, and nerves pass through the thoracic outlet. These structures may be compromised in that area creating different, potential problems. These problems can be related to the nerve or circulatory systems. Neurological symptoms can include: sensation loss in the arm down to the ring and little finger, hand weakness, and pain. Occasionally, there is an associated extra cervical rib above the normal first rib with Thoracic Outlet Syndrome For More Information: American Chronic Pain Association - www.theacpa.org National Institute of Neurological Disorders and Stroke - www.ninds.nih.gov

43. Thoracic Outlet Syndrome. Acupuncture Today, December 2001 Frequently orthopedists, neurologists or chiropractors refer patientswith a diagnosis of thoracic outlet syndrome. This article http://www.acupuncturetoday.com/archives2001/dec/12katz.html

Other MPAmedia Alternative Health Site Links Chiropractic ChiroExpo.com ChiroWeb.com DynamicChiropractic.com Massage Therapy MassageToday.com Dr. Katz's Corner Alejandro J. Katz, MD, OMD, LAc, QME Thoracic Outlet Syndrome Frequently orthopedists, neurologists or chiropractors refer patients with a diagnosis of thoracic outlet syndrome. This article will help you know what it is and how to treat it. The symptoms of thoracic outlet syndrome (TOS) are pain, numbness and tingling of the upper extremity. The compression of the brachial plexus, subclavian artery and vein between the clavicle, first rib and the scalene muscles seems to be the cause. The nerves mostly affected are the radial; ulnar (90% of the cases); median; and musculoskeletal nerves. The patient's symptoms are pain/tingling/burning of the forearm/hand/fingers (third, fourth and fifth fingers). The pain medications usually prescribed include ibuprofen (600-800 mgs 2/3 times a day), naproxen (500 mgs two times/day), vioxx (12.5/25/50 mgs) or celebrex (100/200 mgs). A diagnostic test that could be used for TOS is a nerve conduction study (NCS), which will show whether an abnormality is present (the test's results are usually inconsistent).

44. General Hip Pain Abdominal Pain Hypertension Allergy Hyperthyroid thoracic outlet syndrome. I am a 51 year old former medical secretary.I am being treated for my pain secondary to a left distal http://www.taosacu.com/thoracic.htm

General Hyperthyroid Abdominal Pain Irritable Bowel Syndrome ... Hypertension Thoracic Outlet Syndrome "I am a 81 year old woman with osteoarthritis for years in my hands, neck, lumbar spine and both hips. In order to avoid medication of NSAD to upset my stomach, raise my blood pressure and the concern of damaging my kidney, I decided to try acupuncture. After about 5 treatments, I feel I have almost no pain at all, the spasm of by trapezius muscle also much reduced. I am glad I could maintain this health condition without side effects." ~Elva Lower "O ~Merjorie Genicola "I am a 51 year old former medical secretary. I am being treated for my pain secondary to a left distal acromial fracture sustained while at work. I was reaching for a chair and the chair rolled and struck my outstretched hand, causing the fracture of the left acromion. Over the years I tried numerous medications, however, most of these could only be taken transiently because of side effects. An MRI shows I have a full thickness defect involving the supraspinatus tendon and a partial thickness tear of the infraspinatus tendon and left shoulder confirmed the full thickness rotator cuff tear. I received surgery on Feb 14, 2000 at Sacred Heart Hospital. Unfortunately, my shoulder pain even gets better like 50% from constant pain to intermediate pain, however, some additional pain

45. Thoracic Outlet Syndrome Discussion thoracic outlet syndrome Discussion. thoracic outlet syndrome refersto a variety of problems which may occur along the paths that http://www.eatonhand.com/dis/dis155.htm

Thoracic outlet syndrome Discussion Thoracic outlet syndrome refers to a variety of problems which may occur along the paths that are taken by major blood vessels and nerves as they cross from the chest cavity to the upper arm. Diagnosis and treatment are controversial, as there may be difficulty establishing the diagnosis and prognosis with objective testing. Intervention is usually not indicated unless there are objective abnormalities such as abnormal venogram or clear electrodiagnostic evidence of localized neuropathy. In the absence of objective evidence, this diagnosis should be managed by a limited postural therapy program. Discussion Home Page e-Hand Home Page

46. Thoracic Outlet Syndrome; Treatment, Prevention, Cure thoracic outlet syndromeSearch information from many of the best Thoracic OutletSyndrome health sites. thoracic outlet syndrome message board/forum. http://www.healthlinkusa.com/content/308.html

Latest Health News Find Drug Information Health Calculators All Words Any Words A B C D ... Z Sunday, March 30, 2003 Alternative therapy struggles to bridge East-West divide Click here to read more Doctors are not following guidelines recommending flu and pneumonia vaccinations for hospitalized adults, leaving millions of elderly patients vulnerable to potentially deadly ailment Click here to read more A helping hand for uninsured; Agencies find ways to provide health care for area children Click here to read more The government has approved the first generic version of the acne drug, Accutane Click here to read more Gates to give India $100m for AIDS; Microsoft CEO begins controversy-laced trip to fight virus Click here to read more Allergies and Asthma Alternative Medicine Arthritis and Your Health ... Women's Health Monday March 31, 2003 Spina Bifida: Spina Bifida is a rare birth disorder, affecting approximately 1 in 12-1400 live births. Click here to learn more Craniosynostosis: Sagittal Synostosis...males are affected about three times as often as females. Click here to learn more Spinal Cord Injury: Acts of violence have now overtaken falls as the second most common source of spinal cord injury.

47. HealthlinkUSA Thoracic Outlet Syndrome Links Friday February 7, 2003. The healthy way to search today's best sites.Links to websites which may include treatment, cures, diagnosis http://www.healthlinkusa.com/308ent.htm

48. The Difficult-to-diagnose Thoracic Outlet Syndrome thoracic outlet syndrome (TOS) may be more prevalent than you think. The Difficultto-Diagnosethoracic outlet syndrome. by Warren Hammer,MS,DC,DABCO http://www.chiroweb.com/archives/18/04/07.html

Search ChiroWeb! Other MPAmedia Alternative Health Site Links Acupuncture AcupunctureToday.com Massage Therapy MassageToday.com The Difficult-to-Diagnose Thoracic Outlet Syndrome by Warren Hammer,MS,DC,DABCO Thoracic outlet syndrome (TOS) may be more prevalent than you think. It is a condition that requires a diagnosis made more by a history and physical examination than by radiological or electrodiagnostic tests. While cervical ribs and other anatomic variations may be more common in TOS, they are not necessarily a prerequisite for a diagnosis. Of the 282 patients who required surgery for TOS, two-thirds had had normal electromyography testing results. The problem with establishing a diagnosis is that since both nerves and blood vessels may be compressed, a patient may present with a variety of signs and symptoms. Originally, it was thought that vascular compression created most of the symptoms, but recent studies show that neural compression is responsible for most of the complaints. Forty-one percent of the 282 patients had a history of trauma preceding the onset of symptoms, with the shoulder girdle most affected, followed by the neck, arm and hand. Thirty-two percent of the patients blamed their symptoms on the workplace. Poor posture was a significant cause.

49. Posttraumatic Cervico-Axillary Syndrome (Thoracic Outlet Syndrome) Posttraumatic CervicoAxillary Syndrome (thoracic outlet syndrome). Thoracic outletsyndrome (TOS) is a documented sequella of whiplash-CAD type injuries. http://www.chiroweb.com/archives/16/12/05.html

Search ChiroWeb! Other MPAmedia Alternative Health Site Links Acupuncture AcupunctureToday.com Massage Therapy MassageToday.com Posttraumatic Cervico-Axillary Syndrome (Thoracic Outlet Syndrome) by David BenEliyahu, DC, DABCSP, DAAPM Thoracic outlet syndrome (TOS) is a documented sequella of whiplash-CAD type injuries. In a study by Magnusson et al., 31 percent of the patients they studied who were injured in an MVA (motor vehicle accident) developed TOS. In a retrospective study on the incidence, etiology, diagnosis and management of TOS that I am currently working on, we have found that about 40 percent of whiplash-CAD patients will develop posttraumatic TOS. This syndrome presents with a constellation of signs and symptoms in the upper extremity, often including pain, parasthesias, weakness and temperature changes in the arms and hands. It is often exacerbated by provocational arm movements, usually in hyperabduction. The patient will display symptoms from myofascial, neurologic and vascular structures. After a whiplash injury, the scalenes and pectoralis minor muscle become stretched and injured, developing fibrotic adhesions and becoming taut and hypertonic. This can cause myofascial referred pain into the extremity, but can also lead to entrapment of the associated neurovascular bundle. The first rib will often exhibit joint dysfunction, either due to traumatic subluxation or abnormal pull from the hypertonic scalenes. To successfully treat these disorders requires manual techniques such as active myofascial release; spray and stretch; cervical and rib manipulation therapy or mobilization; and home care exercises.

50. Thoracic Outlet Syndrome extremity as they enter the arm. thoracic outlet syndrome is a compressiveneurovascular disorder of the upper extremity. Etiology. http://ortho.hyperguides.com/Tutorials/hand/thoraoutlet/tutorial.asp

window.location="http://www.ortho.hyperguides.com/"; Thoracic Outlet Syndrome H. Matthew Quitkin, MD Melvin Rosenwasser, MD Introduction Etiology Symptoms Diagnosis ... Bibliography Introduction The thoracic outlet is comprised of the musculoskeletal structures traversed by the nerves and blood vessels to the upper extremity as they enter the arm. Thoracic outlet syndrome is a compressive neurovascular disorder of the upper extremity. Etiology There are several potential sites of compression ( Sternocostovertebral space: Bordered by the sternum anteriorly, the spine posteriorly, and the first rib laterally. Interscalene interval: Formed by the anterior and middle scalene muscles and the first rib inferiorly. The subclavian artery and brachial plexus travel through this space, while the subclavian vein passes anterior to it. This is the most commonly described site of compression. Costoclavicular space: Bordered by the clavicle and the first rib. Subcoracoid: Between the pectoralis minor anteriorly and the ribs posteriorly.

51. Thoracic Outlet Syndrome thoracic outlet syndrome. Melvin P. Rosenwasser, MD Professor of OrthopedicSurgery Columbia University College of Physicians and http://ortho.hyperguides.com/Tutorials/hand/thoraoutlet/default.asp

window.location="http://www.ortho.hyperguides.com/"; Thoracic Outlet Syndrome Melvin P. Rosenwasser, MD Professor of Orthopedic Surgery Columbia University College of Physicians and Surgeons; Attending Orthopedic Surgeon of the New York-Presbyterian Hospital New York, New York H. Matthew Quitkin, MD Orthopedic Surgery MANUS Center Vienna, Virginia

52. UCLA Surgery | Thoracic Outlet Syndrome UCLA Surgery Home Page thoracic outlet syndrome. thoracic outlet syndrome. PagetSchroettersyndrome, a subset of TOS. What is thoracic outlet syndrome? http://www.surgery.medsch.ucla.edu/vascular/dx_TOS.shtml

UCLA Surgery Home Page Overview Doctors Nurse Practitioner ... Contact Us Thoracic Outlet Syndrome Paget-Schroetter syndrome, a subset of TOS What is Thoracic Outlet Syndrome? What causes Thoracic Outlet Syndrome? Many things can cause thoracic Outlet Syndrome, as a number of abnormalities can develop in the thoracic outlet area. For example: Some people are born with an extra rib called a "cervical rib". Although most often this causes no particular problem, under certain circumstances the can narrow the opening in the thoracic outlet area and cause compression. Other people may be born with a smaller opening. Most frequently, the symptoms begin after an injury or accident, or after some repetitive movements such as computer work or swimming. Activities that cause enlargement of the scalene muscle, such as weight lifting, can also cause symptoms. What are the usual symptoms of Thoracic Outlet Syndrome? Symptoms always involve the upper extremities. Numbness, tingling, weakness and pain in the arm and hand are the most common symptoms. However, there are many other symptoms as well. Some patients have swelling of the arm and hand. Some patients only have pain if they are doing an activity that requires their arms to be raised such as brushing their hair. Temperature changes of the extremity can occur. Other symptoms that are quite common include pain in the shoulder, back, neck and head. Many people have thoracic outlet problems on both sides, although one side is usually worse than the other.

53. Thoracic Outlet Syndrome thoracic outlet syndrome Alternative Names true neurogenic thoracic outlet syndrome,disputed thoracic outlet syndrome, arterial thoracic outlet syndrome http://www.jewishhospital.org/healthinfo/encyclopediaHTML/1794.html

Jewish Hospital: Health Information Quick Links - Job Opportunities - Patient Pre-Registration - Register for Email News - Health Information - Ways to Give - The Trager Pavilion - Neuroscience - Occupational Health - Organ Transplantation - Outpatient Care ... Special Topics Thoracic outlet syndrome Alternative Names true neurogenic thoracic outlet syndrome, disputed thoracic outlet syndrome, arterial thoracic outlet syndrome Definition Thoracic outlet syndrome includes those disorders that result in compression of nerves or blood vessels supplying the arms. What is going on in the body? The thoracic outlet is the area of the body between the collarbone and the rib cage. Veins, nerves, and arteries come through this opening. When the blood vessels or nerves are compressed or squeezed, the pressure causes the symptoms of thoracic outlet syndrome. What are the signs and symptoms of the disease? Symptoms of thoracic outlet syndrome include: shoulder pain that increases in certain positions arm pain hand pain, especially in the ring finger and little finger

54. Thoracic Outlet Syndrome thoracic outlet syndrome. Archie R McGowan, MD Benjamin B Faitelson MD. Diagnosis.thoracic outlet syndrome with bilateral subclavian vein thrombosis. Discussion. http://brighamrad.harvard.edu/Cases/bwh/hcache/170/full.html

Thoracic Outlet Syndrome Archie R McGowan, MD Benjamin B Faitelson MD Presentation A 27-year-old man presented with acute left arm swelling and discomfort which had wakened him from sleep. Notably, this is a large, muscular man with a recent history of increased upper body exercise, plane travel and chiropractic manipulations of his neck and upper extremity. Imaging Findings Cut film venogram of the left subclavian vein Angioplasty of the left subclavian vein Digital venogram of the right subclavian vein A cut film venogram demonstrates complete occlusion of the patient's left subclavian vein ( arrow ) where it crosses the first rib. Also of importance are the multiple dilated collateral vessels suggesting chronicity. The second image demonstrates an attempt at angioplasty of this compressed and thrombosed vessel ( arrow Digital venography of the contralateral side shows bilaterality of the subclavian vein thrombosis ( arrow ) (although the patient is asymptomatic on the right side). Diagnosis Thoracic outlet syndrome with bilateral subclavian vein thrombosis Discussion Thoracic outlet syndrome is a disease of extrinsic compression of the artery, vein, or nerve at the thoracic outlet. This patient demonstrates subclavian vein thrombosis.

55. Thoracic Outlet Syndrome Subject thoracic outlet syndrome Topic Area Thoracic Forum The Neurology andNeurosurgery Forum Question Posted By Lisa on Monday, October 18, 1999 My http://www.medhelp.org/forums/neuro/messages/30178a.html

Advertisement Welcome to Med Help International A not-for-profit organization Questions in The Neurology Forum are being answered by doctors from The Cleveland Clinic , consistently ranked one of the best hospitals in America. Subject: Thoracic Outlet Syndrome Topic Area: Thoracic Forum: The Neurology and Neurosurgery Forum Question Posted By: Lisa on Monday, October 18, 1999 My Orthopedist and Neurologist think I have Thoracic Outlet Syndrome. I know this is very difficult to diagnose and is often misdiagnosed with surgery being performed unnecessarily. I do have the cervical rib and lose the pulse when the arm is raised. I've had an EMG but I am now being told that it was done incorrectly so another will be done tomorrow. Is there any other way of diagnosing this? I have a lot of shoulder and neck pain as well as tingling in the hand and fingers, especially when the arm is raised at all. The neurologist says that if I did need surgery there are only four places in the US that he would send his patient. He only mentioned two, which were LSU and The Cleveland Clinic. If I'm told I have TOS I want it proven to me that I really do have it! Is there a test that will definitely show it? Thank you very much.

56. Deep Venous Thrombosis - Thoracic Outlet Syndrome Subject Deep Venous Thrombosis thoracic outlet syndrome Topic Area ThoracicForum The Neurology and Neurosurgery Forum Question Posted By Robert on http://www.medhelp.org/forums/neuro/archive/15267.html

Advertisement Welcome to Med Help International A not-for-profit organization Questions in The Neurology Forum are being answered by doctors from The Cleveland Clinic , consistently ranked one of the best hospitals in America. Subject: Deep Venous Thrombosis - Thoracic Outlet Syndrome Topic Area: Thoracic Forum: The Neurology and Neurosurgery Forum Question Posted By: Robert on Saturday, January 16, 1999 I am 28 year old male with a history of thrombosis in the right subclavean vein. The thrombosis has been attributed to thoracic outlet syndrome. The first case of thrombosis was found when I was 18 years old. Symptons included pain, swelling, discoloration tingling in the fingers etc.. At the time I was put on a Heparin drip which eventually led to coumadin (warfarin) daily for a number of years. After stoppping the coumadin (2 years later) everything seemed fine until aproximately 6 months later when there was a reoccurence of the clotting. I have had similar problems every time I go off the coumadin. In my last episode clotting did not occur until I was off the Coumadin for almost 4 years. I was participating in more sports and trying to get back into shape. The clotting has reoccurred 4 or 5 times over the last 10 years and my Vascular Surgeon has reluctantly suggested that the only thing left to try is a Thoracic Outlet Decompression Surgery. I am obviously reluctant to go under the knife but I do wish to eventually lead a normal life again. I really don't want to be on coumadin for the rest of my life.

57. Florida State University College Of Medicine Digital Library thoracic outlet syndrome Patient/Family Resources. See also General CardiovascularPatient/Family Resources; thoracic outlet syndrome Clinical Resources. http://fsumed-dl.slis.ua.edu/patientinfo/cardiology/cardiovascular/pvd/arterial/

Patient/Family Resources by Topic: Cardiovascular Thoracic Outlet Syndrome Patient/Family Resources Spanish Miscellaneous See also: General Cardiovascular Patient/Family Resources Thoracic Outlet Syndrome Clinical Resources MD Consult: Homepage Medical Library subscription INFO Patient Handouts Table of content Thoracic Outlet Syndrome: Access document National Institute of Neurological Disorders and Stroke: Homepage Disorders Information: List of documents Thoracic Outlet Syndrome: Access document MEDLINE plus Medical Encyclopedia: Table of contents Thoracic Outlet Syndrome: English Spanish Merck Manual Home Edition Table of contents Chapter 70. Peripheral Nerve Disorders: Access document Spanish MEDLINE plus Medical Encyclopedia: Table of contents Thoracic Outlet Syndrome: English Spanish Miscellaneous Thoracic Outlet Syndrome Patient/Family Resources National Library of Medicine MEDLINE plus Health Topics: Index Thoracic Outlet Syndrome: List of documents YAHOO - Health:Diseases and Conditions:Thoracic Outlet Syndrome Additional Thoracic Outlet Syndrome resources ( These sites have not been reviewed.

58. Florida State University College Of Medicine Digital Library thoracic outlet syndrome Clinical Resources. Wheeless' Textbook of OrthopaedicsTable of contents thoracic outlet syndrome Access document. http://fsumed-dl.slis.ua.edu/clinical/cardiology/cardiovascular/pvd/arterial/tho

Clinical Resources by Topic: Cardiovascular Disorders Thoracic Outlet Syndrome Clinical Resources Emergency Radiology Clinical Guidelines News ... Miscellaneous Resources See also: Cardiovascular Clinical Procedure Resources General Cardiovascular Disorders Clinical Resources Thoracic Outlet Syndrome Patient/Family Resources Harrison's Principles of Internal Medicine 15th Ed.-2001: Table of contents Medical Library subscription INFO Chapter 248: Vascular Diseases of the Extremities Table of contents Arterial Disorders: Access document Thoracic Outlet Compression Syndrome: Access document Treatment: Access document DeLee: DeLee and Drez's Orthopaedic Sports Medicine 2nd Ed.-2003 (MD Consult): Table of contents Medical Library subscription INFO Chapter 21 - Shoulder: Access document Section O Thoracic Outlet Syndrome: Access document History: Access document Anatomy: Access document Symptoms: Access document Physical Examination: Access document Provocative Signs: Access document Diagnostic Studies: Access document Nonsurgical Treatment: Access document Surgical Treatment: Access document Criteria for Return to Sports Participation: Access document Authors' Preferred Method of Treatment: Access document References: Access document Goetz: Textbook of Clinical Neurology 1st Ed.-1999 (MD Consult):

59. Surgery For Thoracic Outlet Syndrome (TOS). [NGC:1126] TITLE Surgery for thoracic outlet syndrome (TOS). CLINICAL ALGORITHM(S) An algorithmis provided for the criteria for surgery of thoracic outlet syndrome. http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=1126&sSearch_strin

60. RSI Program- 3D-MRA Of Thoracic Outlet Syndrome Wonthly Column Not Monthly, But Whenever We Get Around To It URGENT InformationMeasured Evidence of thoracic outlet syndrome (All Articles). http://www.rsiprogram.com/articles/collins.htm

Home: RSIProgram.com "Wonthly" Column- Not Monthly, But Whenever We Get Around To It URGENT Information: Measured Evidence of Thoracic Outlet Syndrome ( All Articles Synopsis: Courtesy of a Sorehander, the information below presents the most important development I know of in RSI. With this new info, we propose that computer-related RSI is caused first-and-foremost by Thoracic Outlet Syndrome. We suggest that the greatest generalization among computer users is that the problem starts with circulation and the chain reaction begins at the chest and neck, as a result of the "gargoyle" posture of computer work. Although generalizations are often derided, we think that more good than harm is done by placing attention on this no-longer-hidden weak point in the human anatomy and its relation to fixed-posture, arms-suspended work. Medical literature further emphasizes anatomical anomalies such as muscle arrangement and fibrous bands in this area that can easily explain different susceptibilities among individuals, a frequent source of mystery for sufferers. UCLA's Dr. Collins Documents the Diagnosis of Thoracic Outlet Syndrome

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