Daley Pauline, Pomares Germain, Gross Raphael, Menu Pierre, Dauty Marc, Fouasson-Chailloux Alban
Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France.
Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France.
J Clin Med. 2022 Sep 2;11(17):5206. doi: 10.3390/jcm11175206.
Neurogenic thoracic outlet syndrome (NTOS) is a disabling condition. Its diagnosis remains challenging and is mainly guided by examination. Yet, electrophysiological evaluations are the gold standard for diagnosis of entrapment syndromes. We aimed to assess the interest of electrophysiological evaluation to diagnose NTOS. A systematic literature research was performed using PubMed, ScienceDirect, Embase, Cochrane and Google Scholar databases to collect studies reporting results of electrophysiological assessment of patients with NTOS. Then, a meta-analysis was conducted. Nine studies were eligible and concerned two hundred and thirteen patients. Results were heterogenous among studies and the quality of evidence was very low to moderate. Data could not evaluate sensitivity or specificity of electrophysiological evaluations for NTOS. The meta-analysis found significantly decreased amplitudes of medial antebrachial cutaneous nerve SNAP (sensory nerve action potential), ulnar SNAP, median CMAP (compound motor action potential) and ulnar CMAP. Needle examination found abnormalities for the abductor pollicis brevis, first dorsal interosseous and adductor digiti minimi. Unlike most upper-limb entrapment syndromes, nerve conduction assessment only provided clues in favour of NTOS. Decreased amplitude for ulnar SNAP, medial antebrachial cutaneous SNAP, median CMAP and ulnar CMAP should be assessed, as well as needle examination. Larger studies are needed to evaluate the sensitivity and specificity of electrophysiology in NTOS diagnosis.
神经源性胸廓出口综合征（NTOS）是一种致残性疾病。其诊断仍然具有挑战性，主要依靠体格检查来指导。然而，电生理评估是诊断卡压综合征的金标准。我们旨在评估电生理评估对诊断NTOS的价值。通过使用PubMed、ScienceDirect、Embase、Cochrane和谷歌学术数据库进行系统的文献检索，以收集报告NTOS患者电生理评估结果的研究。然后，进行了一项荟萃分析。九项研究符合条件，涉及213名患者。研究结果之间存在异质性，证据质量从非常低到中等。数据无法评估电生理评估对NTOS的敏感性或特异性。荟萃分析发现，臂内侧皮神经感觉神经动作电位（SNAP）、尺神经SNAP、正中神经复合肌肉动作电位（CMAP）和尺神经CMAP的波幅显著降低。针极肌电图检查发现拇短展肌、第一背侧骨间肌和小指展肌有异常。与大多数上肢卡压综合征不同，神经传导评估仅提供支持NTOS的线索。应评估尺神经SNAP、臂内侧皮神经SNAP、正中神经CMAP和尺神经CMAP的波幅降低情况，以及针极肌电图检查结果。需要更大规模的研究来评估电生理检查在NTOS诊断中的敏感性和特异性。
