Sanders Richard J, Annest Stephen J
Presbyterian/St. Luke's Medical Center, 1719 Gilpin, Denver, CO 80218.
Presbyterian/St. Luke's Medical Center, 1719 Gilpin, Denver, CO 80218.
Semin Vasc Surg. 2014 Jun;27(2):86-117. doi: 10.1053/j.semvascsurg.2015.02.001. Epub 2015 Feb 18.
Compression of the neurovascular bundle to the upper extremity can occur above or below the clavicle; thoracic outlet syndrome (TOS) is above the clavicle and pectoralis minor syndrome is below. More than 90% of cases involve the brachial plexus, 5% involve venous obstruction, and 1% are associate with arterial obstruction. The clinical presentation, including symptoms, physical examination, pathology, etiology, and treatment differences among neurogenic, venous, and arterial TOS syndromes. This review details the diagnostic testing required to differentiate among the associated conditions and recommends appropriate medical or surgical treatment for each compression syndrome. The long-term outcomes of patients with TOS and pectoralis minor syndrome also vary and depend on duration of symptoms before initiation of physical therapy and surgical intervention. Overall, it can be expected that >80% of patients with these compression syndromes can experience functional improvement of their upper extremity; higher for arterial and venous TOS than for neurogenic compression.
神经血管束对上肢的压迫可发生在锁骨上方或下方；胸廓出口综合征（TOS）发生在锁骨上方，而胸小肌综合征发生在锁骨下方。超过90%的病例累及臂丛神经，5%涉及静脉阻塞，1%与动脉阻塞有关。本文介绍了神经源性、静脉性和动脉性TOS综合征的临床表现，包括症状、体格检查、病理、病因以及治疗差异。这篇综述详细阐述了区分相关病症所需的诊断测试，并针对每种压迫综合征推荐了适当的药物或手术治疗方法。TOS和胸小肌综合征患者的长期预后也有所不同，且取决于开始物理治疗和手术干预前症状的持续时间。总体而言，可以预期，超过80%的这些压迫综合征患者的上肢功能能够得到改善；动脉性和静脉性TOS患者的改善程度高于神经源性压迫患者。
