Thoracic Outlet Syndrome

Question 1

Define thoracic outlet syndrome

Answer 1

compression of one or more of the neurovascular structures in the superior aperture of the chest

Question 2

What is the primary objective test for thoracic outlet syndrome

Answer 2

reduction of normal function velocities of the ulnar and median nerve across the thoracic outlet

Question 3

Should the electromyelogram be normal in thoracic outlet syndrome

Answer 3

yes

Question 4

If nerve conduction velocities are greater than 60mpersec how should thoracic outlet syndrome be treated

Answer 4

conservative phsyical therapy

Question 5

What does conservative phsyical therapy entail for thoracic outlet syndrome

Answer 5

improving posture, strengthening the shoulder girlde and loosening of the neck muscles

Question 6

What are the indications for surgery in thoracic outlet syndrome

Answer 6

failure of conservative therapy, reduced nerve conduction velocity less than 60mpersec, arterial aneurysm, emboli or occlusion of the artery or vein

Question 7

Describe the initial surgical therapy for thoracic outlet syndrome

Answer 7

anterior scalenectomy, resection of the first rib and costoclavicular ligament, neurolysis of C7, C8, T1 nerve roots and the brachial plexus

Question 8

What vascular structures must be avoided when dissecting the first rib subperiosteally

Answer 8

subclavian artery or vein

Question 9

What approach is used if thoracic outlet syndrome is due to aneurysms or emboli

Answer 9

supraclavicular approach with first rib resection

Question 10

Name the surgical approach for the following: nerve compression, arterial compression, venous compression, recurrent

Answer 10

nerve: transaxillary; arterial: supraclavicular and infraclavicular; venous: transaxillary; recurrent: posterior high thoracoplasty

Question 11

What nerves should be identified during surgery for thoracic outlet syndrome

Answer 11

long thoracic and brachial plexus

Question 12

Define Paget-Schroetter syndrome

Answer 12

thrombosis of the axillary subclavian vein

Question 13

What is the cause of Paget-Schroetter syndrome

Answer 13

unusual or excessive use of the arm in addition to a congenitally abnormal insertion of the costoclavicular ligament laterally

Question 14

How is Paget- Schroetter syndrome treated

Answer 14

resection of the first rib through a trans-axillary approach

Question 15

How is recurrent thoracic outlet syndrome treated

Answer 15

surgery and then methylprednisolone and hyaluronic acid to minimize recurrent scar