Next Article in Journal
Advancing Point-of-Care (PoC) Testing Using Human Saliva as Liquid Biopsy
Next Article in Special Issue
Pectoralis Minor Syndrome: Subclavicular Brachial Plexus Compression
Previous Article in Journal
Salivary Immune and Metabolic Marker Analysis (SIMMA): A Diagnostic Test to Predict Caries Risk
Previous Article in Special Issue
Choosing Surgery for Neurogenic TOS: The Roles of Physical Exam, Physical Therapy, and Imaging
Article Menu

Export Article

Open AccessArticle
Diagnostics 2017, 7(3), 40; doi:10.3390/diagnostics7030040

Ultrasonographic Diagnosis of Thoracic Outlet Syndrome Secondary to Brachial Plexus Piercing Variation

1
Department of Osteopathic Manipulative Medicine, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308, USA
2
Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308, USA
3
Department of Anatomy, Midwestern University, Glendale, AZ 85308, USA
4
School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287, USA
*
Author to whom correspondence should be addressed.
Received: 28 April 2017 / Revised: 26 June 2017 / Accepted: 29 June 2017 / Published: 4 July 2017
(This article belongs to the Special Issue Diagnosis and Treatment of Thoracic Outlet Syndrome)
View Full-Text   |   Download PDF [8995 KB, uploaded 4 July 2017]   |  

Abstract

Structural variations of the thoracic outlet create a unique risk for neurogenic thoracic outlet syndrome (nTOS) that is difficult to diagnose clinically. Common anatomical variations in brachial plexus (BP) branching were recently discovered in which portions of the proximal plexus pierce the anterior scalene. This results in possible impingement of BP nerves within the muscle belly and, therefore, predisposition for nTOS. We hypothesized that some cases of disputed nTOS result from these BP branching variants. We tested the association between BP piercing and nTOS symptoms, and evaluated the capability of ultrasonographic identification of patients with clinically relevant variations. Eighty-two cadaveric necks were first dissected to assess BP variation frequency. In 62.1%, C5, superior trunk, or superior + middle trunks pierced the anterior scalene. Subsequently, 22 student subjects underwent screening with detailed questionnaires, provocative tests, and BP ultrasonography. Twenty-one percent demonstrated atypical BP branching anatomy on ultrasound; of these, 50% reported symptoms consistent with nTOS, significantly higher than subjects with classic BP anatomy (14%). This group, categorized as a typical TOS, would be missed by provocative testing alone. The addition of ultrasonography to nTOS diagnosis, especially for patients with BP branching variation, would allow clinicians to visualize and identify atypical patient anatomy. View Full-Text
Keywords: anatomical variation; brachial plexus; superior trunk; middle trunk; anterior scalene muscle; neurogenic thoracic outlet syndrome; ultrasound; provocative testing anatomical variation; brachial plexus; superior trunk; middle trunk; anterior scalene muscle; neurogenic thoracic outlet syndrome; ultrasound; provocative testing
Figures

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

Supplementary material

Scifeed alert for new publications

Never miss any articles matching your research from any publisher
  • Get alerts for new papers matching your research
  • Find out the new papers from selected authors
  • Updated daily for 49'000+ journals and 6000+ publishers
  • Define your Scifeed now

SciFeed Share & Cite This Article

MDPI and ACS Style

Leonhard, V.; Caldwell, G.; Goh, M.; Reeder, S.; Smith, H.F. Ultrasonographic Diagnosis of Thoracic Outlet Syndrome Secondary to Brachial Plexus Piercing Variation. Diagnostics 2017, 7, 40.

Show more citation formats Show less citations formats

Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Related Articles

Article Metrics

Article Access Statistics

1

Comments

[Return to top]
Diagnostics EISSN 2075-4418 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top