md:thoracicoutletsyndrome
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md:thoracicoutletsyndrome [2019/07/20 07:35] admin created |
md:thoracicoutletsyndrome [2020/03/24 02:34] (current) |
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| ====Anatomy==== | ====Anatomy==== | ||
| - | shoulder - tripod on thorax | + | * shoulder - tripod on thorax |
| + | * scalene muscles | ||
| + | * vessels - fixed at posterior circumflex humeral and proximal subclavian | ||
| + | * nerves - brachial plexus | ||
| ====Pathoanatomy==== | ====Pathoanatomy==== | ||
| - | abnormal bony structure vs normal structure in abnormal position | + | * Cause: |
| + | * Cervical rib: bony parts, fibrous, clavicular fractures | ||
| + | * Site: | ||
| + | * 3rd part of subclavian | ||
| + | * or axillary - pect minor/ humeral head | ||
| + | * posterior circumflex humeral artery | ||
| ====Presentations==== | ====Presentations==== | ||
| - | * splinter hemorrhages | + | |
| - | * arm claudication vs " | + | * arm claudication vs " |
| - | * digital gangrene/ | + | * digital gangrene/ |
| - | * raynaud' | + | * raynaud' |
| - | * neurogenic symptoms (30%) - true vs disputed | + | * neurogenic symptoms (30%) - true vs disputed |
| - | * pulsatile neck mass | + | * pulsatile neck mass |
| ====Evaluation=== | ====Evaluation=== | ||
| - | * history: overuse/ direct trauma | + | |
| - | * physical | + | * physical |
| - | - position of use | + | - position of use |
| - | - arterial exam | + | - arterial exam |
| ====Investigations==== | ====Investigations==== | ||
| - | * need good imaging in correct position | + | |
| - | + | * need proper angiogram in position of use | |
| - | 3rd part of subclavian | + | ====Abnormal bony structures - principles |
| - | or axillary | + | * decompression |
| - | posterior circumflex humeral artery | + | * reconstruction |
| + | * peripheral emboli | ||
| - | need proper angiogram in position of use | + | ====Surgery==== |
| - | + | * Prep: Ix: 3D recon with CTA | |
| - | ====principles==== | + | |
| - | - decompression - remove aneurysm | + | |
| - | - reconstruction | + | |
| - | - peripheral emboli | + | |
| - | + | ||
| - | Cervical rib | + | |
| - | bony parts, fibrous, clavicular fractures | + | |
| - | + | ||
| - | Ix: 3D recon with CTA | + | |
| - | + | ||
| - | Access | + | |
| - | - supra and infra-clavicular incisions | + | |
| + | ====Pathoanatomy==== | ||
| Normal structures in abnormal positions | Normal structures in abnormal positions | ||
| - | - first rib/ clavicle | + | |
| - | - scalene? | + | - scalene? |
| - | - humeral head | + | - humeral head |
| - | - quadrilateral space | + | - quadrilateral space |
| Humeral head problems | Humeral head problems | ||
| - | - mobilization | + | |
| - | - patch | + | - patch |
| - | - interposition | + | - interposition |
| - | - bypass | + | - bypass |
| Quadrilateral space problem | Quadrilateral space problem | ||
| - | - between teres minor/ major/ two heads of triceps | + | |
| ====Summary==== | ====Summary==== | ||
| - | - unusual problems | + | |
| - | - flexible surgical approach | + | - flexible surgical approach |
| - | - non-medical issues | + | - non-medical issues |
| febe | febe | ||
| Line 73: | Line 72: | ||
| - ? triceps tight | - ? triceps tight | ||
| - finger release | - finger release | ||
| + | |||
| + | ====Cases=== | ||
| + | - Female with shoulder and periscapular pain treated with botox and first rib excision: | ||
| + | * case: https:// | ||
| + | * transaxillary first rib excision: https:// | ||
| ===See also==== | ===See also==== | ||
| https:// | https:// | ||
md/thoracicoutletsyndrome.1563608115.txt.gz · Last modified: 2020/03/24 02:34 (external edit)
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