info pages/sites-
Handchir Mikrochir Plast Chir. 2006 Feb ;38 (1):42-5 16538571
["True neurologic thoracic outlet syndrome" -- anatomical features and electrophysiological long-term follow-up of lateral thenar atrophy]
[My paper] U Hug , F J Jung , M Guggenheim , V Wedler , D Burg , W Künzi
[Atrophies of the intrinsic muscles of the hand are considered to be a typical symptom of the "true neurologic" form of thoracic outlet syndrome (TOS). The classical form of this entity was described as early as 1970, consisting of a cervical rib or a prolonged transverse process of C7, complete with a fibrous band to the first thoracic rib, resulting in atrophy of the intrinsic muscles of the hand. All our TOS patients presenting with such atrophy displayed anatomical findings consistent with this definition. Based on this observation, the TOS classification currently in clinical use, which differentiates between "disputed" and "true neurologic" subgroups of the neurologic form, is reviewed. In all cases of "true neurologic TOS" with atrophy of the intrinsic muscles of the hand, the lateral thenar muscles are affected first. We present the electrophysiological long-term results of such thenar atrophies of seven patients with eight operated extremities after brachial plexus decompression. The amplitude of the neurographically measured potential over the opponens pollicis and the abductor pollicis brevis muscle, respectively, was defined as quantitative parameter for muscles atrophy. Neither distinct reinnervation nor progressive denervation was evident in any of the cases after a follow-up period, on average, of more than five years post surgery. These findings are in conflict with clinical observations reporting a major postoperative improvement of the motor deficits.
Mesh-terms: Adolescent; Adult; Brachial Plexus; Cervical Rib Syndrome, diagnosis; Comparative Study; Decompression, Surgical; Diagnosis, Differential; Electrophysiology; English Abstract; Female; Follow-Up Studies; Hand, surgery; Humans; Male; Middle Aged; Muscular Atrophy, etiology; Muscular Atrophy, physiopathology; Thoracic Outlet Syndrome, classification; Thoracic Outlet Syndrome, complications; Thoracic Outlet Syndrome, diagnosis; Thoracic Outlet Syndrome, physiopathology; Thoracic Outlet Syndrome, surgery; Time Factors; Treatment Outcome;]
http://lib.bioinfo.pl/meid:50390
[Clear cut cases of vascular TOS are somewhat easier to identify than neurogenic TOS. Symptoms with which the patient may present to the physician (in addition to those listed above) that are indicative of vascular TOS include:
* Swelling of the arm/hand
* Coldness in the hand/finger
* Bluish color of the hand/finger
* Wasting (atrophy) of the hand (in severe, chronic cases of TOS)
Neurogenic signs are much harder to diagnose definitively as thoracic outlet syndrome. In severe cases, (e.g., hand muscle atrophy), it may be possible to clearly identify compression of the brachial plexus and, although surgery is performed, it does not always resolve the symptoms. For patients who present with sensory symptoms, (e.g., paresthesia, numbness, or pain) there is no test to definitively reach a diagnosis of TOS. Therefore, some health care providers feel that thoracic outlet syndrome is overdiagnosed while others think it is underdiagnosed. Both, however, agree that:
* No single test is reliable to definitively determine a diagnosis of TOS
* Electrodiagnostic studies are typically normal
* Surgery results in little improvement of symptoms
Symptoms follow the pattern of deterioration of the nerve. The aching is related to the muscles that are innervated by the compressed nerve. The compression of nerves is accompanied by complaints of intermittent paresthesia and, finally, numbness. When tested, patients will initially exhibit symptoms only during provocative tests of arm positions and, as the deterioration continues, patients can maintain the elevated position for less and less time due to intense discomfort. Deterioration to the point of muscle atrophy of the hand is rare.]
http://www.medifocushealth.com/RT017...t-Syndrome.php
and the full Google results for the search-Atrophy+TOS
http://www.google.com/search?q=Atrop...ient=firefox-a