Morbidelli A, Miani S, Bortolani E
Minerva Chir. 1989 Apr 15;44(7):1167-72.
The thoracic outlet syndrome (TOS) is caused by compression of the brachial plexus or subclavian artery or vein in the region of the neck and shoulder girdle. The neurovascular bundle may be compressed at multiple sites: costoclavicular space, interscalene triangle, insertion of the pectoralis minor into the coracoid process. More than 90% of the patients present with neurologic symptoms: pain, paraesthesias or arm and hand weakness and 10% also have vascular problems. The diagnosis of TOS is always difficult and depends on careful clinical study of patients. For the neurological type of TOS, electromyograms, arteriograms and venograms are not helpful. The value of Doppler study and of arteriography is demonstrated in the present case of a woman with a five month history of pain and paraesthesias of the arm and hand, who shoved sudden occlusion of left humeral artery. Roentgenograms showed the presence of a well developed left cervical rib. Doppler study and arteriography showed the compression of subclavian artery with the arm abduction manoeuver. After first rib resection and humeral artery thrombectomy there was a complete return of humeral artery flow and of all neurologic functions. Thus the role of first cervical rib or other bone and muscular structures must be emphasyzed both in the brachial and in the subclavian artery or vein compression. Embolization of the axillary or humeral artery should be corrected as soon as possible when the cervical rib is corrected.
胸廓出口综合征（TOS）是由颈肩带区域的臂丛神经、锁骨下动脉或静脉受压引起的。神经血管束可能在多个部位受压：肋锁间隙、斜角肌间隙、胸小肌在喙突的附着处。超过90%的患者出现神经症状：疼痛、感觉异常或手臂和手部无力，10%的患者还存在血管问题。TOS的诊断总是很困难，取决于对患者的仔细临床研究。对于神经型TOS，肌电图、动脉造影和静脉造影并无帮助。在本病例中，一名有手臂和手部疼痛及感觉异常5个月病史的女性突然出现左肱动脉闭塞，多普勒检查和动脉造影的价值得以体现。X线片显示左侧颈肋发育良好。多普勒检查和动脉造影显示手臂外展动作时锁骨下动脉受压。在切除第一肋和行肱动脉血栓切除术之后，肱动脉血流及所有神经功能完全恢复。因此，第一颈肋或其他骨骼和肌肉结构在臂丛神经以及锁骨下动脉或静脉受压中所起的作用必须得到重视。当颈肋问题得到纠正时，应尽快纠正腋动脉或肱动脉的栓塞情况。
