A conservative point of view of the thoracic outlet syndrome

Article Abstract:

A major area of controversy in clinical medicine is thoracic outlet syndrome, a nerve disorder causing numbness, tingling, or a 'pins and needles' sensation in the fingers. Many authorities believe this syndrome can be treated conservatively and question the use of electrodiagnostic studies, such as electromyography (study of the intrinsic electric activity of the muscle). These views are not often presented in the surgical literature. Various conditions are grouped under the term thoracic outlet syndrome; one group is truly neurogenic (caused by nerves) with definite clinical and electrical findings, while the other group, which does not possess definite objective clinical or laboratory findings, is more frequent and is the one usually treated by surgery. All patients with thoracic outlet syndrome require electrodiagnostic testing. True thoracic outlet syndrome shows very characteristic electrical abnormalities, including electromyographic documentation of changes in the small muscles of the hand, decreased amplitude of the ulnar nerve sensory action potential in the forearm, and normal nerve conduction velocities. Many neurologists are reluctant to advise surgery for patients who do not exhibit clinical or electrical abnormalities. Many patients have complications from surgery, and some patients continue to have symptoms after supposedly successful surgery. It is important that the difference between the surgeon's assessment of outcome and that of the patient be presented in the surgical literature. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Electromyography, editorial, Diagnosis, Surgical, Surgical diagnosis

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Scalene muscle abnormalities in traumatic thoracic outlet syndrome

Article Abstract:

Thoracic outlet syndrome (TOS) is a symptom complex resulting from nerve root compression that may be caused by various conditions. In the past nerve root compression by cervical ribs was the most common cause; today the most common cause is nerve compression due to neck injury. It is suggested that the various causes be grouped into osseous (bone) or nonosseous, and traumatic or nontraumatic conditions. Patients with traumatic TOS show a consistent pattern: history of neck trauma; paresthesias (subjective sensation of numbness, tingling, or ''pins and needles'' feeling) in the hands; and pain in the arms, shoulder, neck and head. The cause of traumatic TOS has been suggested to be a combination of the patients' anatomy and acquired pathology of the scalene muscle (muscle attached to the collar bone overlying the brachial plexus - the network of nerves innervating the shoulder and arm). A study was undertaken to determine if there were microscopic abnormalities present in scalene muscles of patients with traumatic TOS; 45 muscle samples were studied. The TOS specimens revealed a consistent abnormal histologic (tissue) pattern seen in the fiber tissue of the muscle and an increase in connective tissue. This finding is compatible with neck trauma. Fibrotic scalene muscles are suggested as an important cause of traumatic TOS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Abnormalities, Causes of, Identification and classification, Muscles

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Management of cavernous hemangioma of the liver

Article Abstract:

Cavernous hemangioma (common tumor made up of large dilated blood vessels) was found on the livers of 12 out of 60 patients evaluated for cancers of the liver. All were women between 29 and 77 years of age. Six patients came to medical attention with abdominal pain and seven had taken estrogen (female hormone). Factors leading to a decision to perform surgery included an uncertain diagnosis, symptoms, an area of damaged tissue greater than six centimeters, and a shortage of oxygen-carrying red blood cells caused by the formation of abnormal red blood cells. The right lobe of the liver was removed in three cases, a segment was removed from the left lobe in one case, a live tissue sample was removed in one case, and three segments were removed from the right lobe in one case. One infection (abscess) under the diaphragm (the muscular partition which separates the chest cavity from the abdominal cavity) and one leak of bile occurred. The tumor had followed a benign course in the remaining seven patients when observed two to six years later. Removal of the tumor may be appropriate in certain patients with large or symptom-causing tumors, but most hemangiomas of the liver follow a benign course.

Care and treatment, Tumors, Hemangioma, Liver tumors

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