Nichols A W
Department of Family Practice and Community Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu 96822, USA.
J Am Board Fam Pract. 1996 Sep-Oct;9(5):346-55.
The array of symptoms that characterize thoracic outlet syndrome (TOS) often lead to a failure or delay in diagnosing this condition in persons who are physically active.
Using the key words and phrases "thoracic outlet syndrome," "sport," "exercise," and "athlete," the MEDLINE files from 1991 to April 1996 were searched. Articles dating before 1991 were accessed by cross-referencing the more recent articles.
TOS results from compression of the neural or vascular structures of the upper extremity at the thoracic outlet. Clinical manifestations can include upper extremity pain, paresthesias, numbness, weakness, fatigability, swelling, discoloration, and Raynaud phenomenon. Four symptom patterns have been described: upper plexus, lower plexus, vascular, and mixed. The lower brachial plexus pattern is the most common. Specific causes of outlet compression include injury to the scalene or scapular suspensory muscles, anomalous fibromuscular bands, cervical ribs, clavicular deformity, and pectoralis minor tendon hypertrophy. The diagnosis of TOS is established on the results of the history and physical examination. Ancillary studies are most helpful to rule out other conditions rather than confirm the diagnosis of TOS. In most cases the initial treatment is nonoperative with an emphasis on rehabilitative exercises for the neck and shoulder girdle. Surgery is indicated for acute vascular insufficiency, progressive neurologic dysfunction, and refractory pain that fails conservative treatment. The surgical technique involves the release or removal of the structures that cause compression and can involve scalene muscle release, first rib resection, cervical rib excision, and resection of fibromuscular bands.
胸廓出口综合征（TOS）的一系列症状常导致对身体活跃人群的这种病症诊断失败或延迟。
使用关键词和短语“胸廓出口综合征”“运动”“锻炼”和“运动员”，检索了1991年至1996年4月的MEDLINE文件。通过对近期文章进行交叉引用获取了1991年以前的文章。
TOS是由上肢神经或血管结构在胸廓出口处受压引起的。临床表现可包括上肢疼痛、感觉异常、麻木、无力、易疲劳、肿胀、变色和雷诺现象。已描述了四种症状模式：上干型、下干型、血管型和混合型。下臂丛型最为常见。出口受压的具体原因包括斜角肌或肩胛悬吊肌损伤、异常纤维肌束、颈肋、锁骨畸形和胸小肌腱肥大。TOS的诊断基于病史和体格检查结果。辅助检查对排除其他病症最有帮助，而非确诊TOS。在大多数情况下，初始治疗是非手术的，重点是颈部和肩胛带的康复锻炼。手术适用于急性血管功能不全、进行性神经功能障碍以及经保守治疗无效的顽固性疼痛。手术技术包括松解或切除引起压迫的结构，可包括斜角肌松解、第一肋切除、颈肋切除和纤维肌束切除。
