Study material for the course: aVLCH0731c, aVLCH0832c, aZLCH0732c, aZLCH0833c
Author: MUDr. Luboš Kubíček, Ph.D.
Department: 2nd Department of Surgery, St. Anne's University Hospital, Faculty of Medicine, Masaryk University in Brno
Main goal of
this lecture is to present a thoracic outlet syndrome (TOS), its etiology and
clinical symptoms. You should learn a basic diagnostic of TOS and use this
knowledge during differential diagnostic process in cases of patient with
problems involving upper limbs. Treatment of TOS is often problematic and
long-term outcomes are not satisfying, however you should know both
conservative and surgical ways of OTS treatment.
TOS is not a
common disease but by its clinical manifestation and treatment difficulties it can
decrease patient´s quality of life significantly. It consists of several
symptoms involving upper limbs, which are based on anatomical predisposition
(anomaly) in combination with long-term straining of the limb (sport, work) or
trauma of neck or shoulder. Diagnostics regarding this disease is not easy and
a key for successful diagnosis is patient medical history and physical
examination and tests. There is many options in differential diagnostics
between TOS and other conditions involving upper limb making this disease even
more difficult to confirm. Treatment can by both conservative and surgical,
long-term effect of TOS treatment is usually not very satisfying.
Time required
for this lecture: 60 minutes
The most important
information from the lecture is that TOS is a is a collection of symptoms
involving upper limb based on anatomical predisposition (anomaly) in
combination with limb straining or trauma in neck or shoulder region. There are
three types of TOS distinguished by the type of structure affected by
compression – neurogenic, venous and arterial TOS. Key to precise diagnose of
TOS is rigorous medical history and physical examination with special tests
amended by X-Ray examination. TOS treatment can be conservative in form of
rehabilitation or decompressive surgery even with bypass implantation.
Long-term outcomes of TOS treatment are not satisfying.
After this
lecture student should be familiar with basic TOS etiology and types. Student
should be able to distinguish symptoms for each type of TOS and use this
knowledge during differential diagnostic process involving upper limb symptoms.
Student should be able not only to distinguish types of TOS but other
conditions with similar symptoms as well. Student should be able to consider
TOS diagnose and direct further investigation to physical tests and X-Ray
examination. Student should be familiar with each type TOS treatment options,
anticipated outcomes a patient prognosis.