Appendix. Suggested Forms to Gather Information from Patients with TOS

Transcription

1 Appendix Suggested Forms to Gather Information from Patients with TOS Three forms seem to be most useful for patients with thoracic outlet syndrome, and we urge all who treat this disorder to use them for data collection: DASH (Disabilities of the Shoulder and Hand ): Copyrighted by The Institute for Work & Health All rights reserved. Obtain at: (September 24, 2012) SF-36 (Short Form - 36 ): Copyrighted by The Medical Outcomes Trust/QualityMetric Incorporated All rights reserved. Obtain at: (September 24, 2012) CBSQ (Cervical Brachial Symptom Questionnaire ): Courtesy of Pain Physician, American Society of Interventional Pain Physicians? Printed on pages to follow. K.A. Illig et al. (eds.), Thoracic Outlet Syndrome, DOI / , Springer-Verlag London

2 692 Appendix

3 Appendix 693

4 694 Appendix Cervical brachial symptom questionnaire Mark where you feel pain with horizontal or vertical lines. Mark sensory changes with diagonal lines. If different pains or specific items in the questionnaire, then indicate by the question number. Use next page if necessary. Name Right Left Left Right or Mark pain or Mark numbness or sensory disturbance including tingling

5 A Adson maneuver, American Association for Thoracic Surgery (AATS), American TOS association site, 676 Arm abducted stress maneuver (AER), 43 Arterial thoracic outlet syndrome (ATOS) abnormal osseous structures, 552 anatomy, Angiojet technique, 593 Arrow-Trerotola PTD device, 593 athletes, 610, 611 arteriography, 566 clinical findings, 566 CT angiography, 566 differential diagnosis, 566, 568 digital plethysmography, 566 ischemic complications, painful and sensitive calluses, 566 physical examination, 566 treatment, axillary artery lesions angiography, 610 branch vessel occlusion, 607 clinical diagnosis, 606 computed tomography/magnetic resonance arteriogram, 606 diagnostic findings, noninvasive vascular laboratory studies, 606, 610 pathogenesis, 605, 606 pathologic and clinical findings, 605 postoperative care, 609 surgical treatment, symptoms, 606 bony abnormalities, 552 children, clinical decision making, clinical pathways, 585, 586 clinical presentation, congenital bony abnormalities cervical ribs, 575 C7 transverse process, evaluation and management, first ribs, neurovascular compression, 571, 572 plain chest and cervical spine radiographs, 571, 572 diagnosis and imaging, 628 differential diagnosis, distal embolization, 593 duplex ultrasound examination, 592 endovascular intervention, endovascular stents, 594 etiology, follow-up, 630 guidewire, 593 imaging studies, intraoperative arteriography, 593 intravascular ultrasound, 594 neurovascular bundle, 583 pathophysiology, , 627 patient history, 553 physical examination, , 592 power-pulse setting, 593 preoperative thrombolysis, 594 provocative testing, 554 rapid pharmacomechanical thrombolysis, 593 recurrent/residual dextran infusion, 621 diagnostic tests, distal emboli, endovascular stent-grafts, etiology, 620 graft thrombosis and embolization, initial therapy, 621 pathology, 620 physical examination, 620 retained abnormal ribs, 623 subclavian artery, treatment, 621 sympathectomy, 624 symptoms, 620 systemic heparin, 621 thrombolytic agents, 621 slow conventional thrombolysis, 593 thrombolysis, 592 timely diagnosis and treatment, 615 treatment, treatment outcomes, Trellis device, 593 unilateral digital ischemia aneurysmal degeneration, 559, 561 catheter-based selective arteriography, 559 differential diagnosis, 558, 559 K.A. Illig et al. (eds.), Thoracic Outlet Syndrome, DOI / , Springer-Verlag London

6 696 Arterial thoracic outlet syndrome (ATOS) ( cont.) digital artery thrombosis, 559 digital ulceration, 557, 558 hypothenar hammer syndrome, 559 physical examination, 557 primary digital artery spasm, 559 primary vasospasm, 558, 559 subclavian artery aneurysm, 559, 560 symptoms, 557 thrombolytic and vasodilator agents, 562 treatment, 559, 562 vascular imaging, 592 whole-limb infusion, 594 Arteriovenous fistula (AVF), 363, , 498 Athletes ATOS, 610, 611 arteriography, 566 clinical findings, 566 CT angiography, 566 differential diagnosis, 566, 568 digital plethysmography, 566 ischemic complications, painful and sensitive calluses, 566 physical examination, 566 treatment, NTOS diagnostic delay, 82 imaging evaluation, 83 NTOS symptoms, 81 pain, 82 physical examination, 81 predisposing activities, treatment and outcomes, unnecessary operative procedure, VTOS anticoagulation, 366 clinical presentation, 366 diagnosis and initial treatment, 366 surgical treatment, Axillary-subclavian vein (ASCV), VTOS, 365 anticoagulation, 366 clinical presentation, 366 diagnosis and initial treatment, 366 surgical treatment, Axillosubclavian artery anatomy, combined supraclavicular and infraclavicular approach, 602 deltopectoral approach, 602 infraclavicular approach, 601, 602 supraclavicular approach general anesthesia, 598 scalene fat pad, transverse supraclavicular incision, 598, 600 B Brachial plexus blocks, 138 Brachial plexus injury, posture and localization, C Carpal tunnel syndrome (CTS), 5, 29, 33, 42 44, 50, 52 53, 59, 70, 89, , 148, 186, 264, 640, 669, 670 Catheter-directed thrombolysis, 509, 510, 529 Central venous obstruction (CVO) definition, 355 dialysis-associated venous thoracic outlet syndrome, endoluminal intervention, pathophysiology of, surgical reconstruction, 358 Cervical and anomalous first ribs, Cervical Brachial Symptom Questionnaire (CBSQ), 45, 152, 688 carpal tunnel syndrome, 53, 54 fibromyalgia, 57 pain and sensory diagram, 46 ulnar neuropathy, 55 Cervical dystonia, 51 Cervical ribs clinical presentation, 87 costal process, embryogenetics, 14 embryology, 85, 86 embryonic nerve trunk, epidemiology, 87 pathophysiology, 87 physical therapy, plain radiograph and CT, 85, 86 surgical intervention, 88 toxic prenatal exposure, 13 Cervical root stimulation (CRS), Chiropractic treatment bio-mechanical function, chronicity factor, 185 future aspects, 186 generic types, 184 manual challenge, 186 pectoral girdle evaluation, 184 proper function re-establishment, sterno-clavicular and acromioclavicular joint, 184 TOS and breathing mechanism, Chronic headache, 55 Complementary and alternative medicine efficacy, 189 erythropoietin, 190 heparin, 190 hypnosis, 190 intraosseous blockade, 190 nalbuphine, 190 nitroglycerine, 190 octreotide, 190 pulsed high intensity magnetic stimulation, topical sphenopalatine ganglion blocks, 191 transcutaneous nerve stimulation, 191 vagal nerve stimulation, 191 Complex regional pain syndrome (CRPS), central/sympathetic mechanisms, classification, 194 clinical features, 195, 648

7 clinical signs, 193 diagnosis, differential diagnosis, 56 epidemiology, 195, 648 genetic factors, 649 historical perspectives, 194 management, nerve injury, 193 pathophysiology brain plasticity, 196 central sensitization, 196 local inflammation, 195 neurogenic edema, 196 skin abnormalities, SNS response, 195 tissue trauma and local nerve injury, 195 peripheral mechanisms, 648 prevention, 651 sympathectomy evolution of, 226 microneurography, 227 results of, sympathetic overactivity, 227 treatment strategies, 196 types, 648 Consensus-based diagnostic criteria clinical features, CORE-TOS, 145 Delphi method, 145, 146 differential diagnosis, future aspects, 152 initial criteria, second-stage limitation, 146 results and analysis, survey construction, Consortium for Outcomes Research and Education on Thoracic Outlet Syndrome (CORE-TOS), 145 Costoclavicular space, 18, 19 D Deep brain stimulation, 264 Diaphragmatic breathing exercise, Disability of the Arm, Shoulder, and Hand (DASH), 45, 62 Double crush syndrome (DCS) anterograde axonal transport, 101, 102 etiology diabetes mellitus, entrapment neuropathy, 102 impaired axonal anterograde flow, 103 inflammation and nerve compression, 102 intrinsic neuropathy, 102 metabolic disorders, 102 motor neuron disease, 103 neuronal injury, thoracic outlet syndrome cubital tunnel syndrome, 103 diagnostic criteria, 103 provocative tests, 103 secondary compression, 103 surgical treatment, 104 Downward arm traction test, 43 Dystonia botulinum chemodenervation muscle biopsy study, 139 neck and shoulder muscle pain, single site injections, 139 cervical, 51 CRPS, E Edgelow neuro vascular entrapment syndrome treatment (ENVEST) protocol, 636 breathing training, cardiovascular conditioning, core stabilizer activation, indications, 169 treatment progression, 173 Electromyography/nerve conduction velocity (EMG/ NCV) test, pectoralis minor syndrome, 97 Elevated arm stress test (EAST), 33, 42 43, 63 F Fibromuscular abnormalities acquired abnormalities, 117 axilla, 119 costoclavicular interval, 119 retropectoralis space, 119 scalene triangle, 119 developmental anomalies, 117 axilla, 119 costoclavicular interval, 119 retropectoralis space, 119 scalene triangle, 117 Fibromyalgia CBSQ diagram, 57 clinical signs and symptoms, 58 medications, 58 G Gilliatt-Sumner hand (GSH) anatomic considerations, 70 anterior supraclavicular approach, 70, 71 intraoperative nerve action potential, 70, 72 posterior subscapular approach, 70, 71 H Hypothenar hammer syndrome, 559 I Imaging modalities CT scan, 121 MRI, radiographs, 121 (see also Radiographic imaging) ultrasound, 121

8 698 Inferior trunk injury, 90 Infraclavicular approach axillosubclavian artery, 601, 602 VTOS clinical outcomes, general endotracheal anesthesia, 430 pectoralis major muscle, 430 postoperative management, 431 residual stenosis, balloon angioplasty, 430, 431 subclavian venolysis, 430, 431 transverse incision, 430 International association for the study of Pain (IASP), 647 Internet American TOS association site, 676 Facebook, 678 MedlinePlus, 676, 677 National Institutes of Health s web site, 676, 677 NINDS, 677 parent usage, 676 physician website, quality health care, 675 recommendations, 676 searching Thoracic Outlet, 679 Society for Vascular Surgery website, 676 videos, 679 WebMD network, 678 Wikipedia, 678 Intravascular ultrasound (IVUS), , 466, 528, 594 K Kabat test, 64 L Lateral cord injury, 90 Latissimus dorsi muscle (LDM) transfer fl ap external neurolysis, 287 muscle flap insertion, patient positioning, 286, 287 supraclavicular brachial plexus neurolysis, 287, 288 transaxillary dissection, 286, 287 M Medial antebrachial cutaneous nerve (MACN) testing, 129, 130 Medial claviculectomy, VTOS axillary-subclavian-innominate vein, 448 clavicle incision, 447 oscillating saw, 448 periosteal elevator, results, Medial cord injury, 90 Medicolegal issues claims, 663 physician as defendant, physician as expert witness, physician as witness, 664 MedlinePlus, 676, 677 Motor cortex stimulation, 265 Myofascial pain, N National Institute of Neurological Disorders and Stroke (NINDS), 677 National Institutes of Health s web site, 676, 677 Nerve conduction velocity (NCV), 232 Nerve injuries, Neurogenic pectoralis minor syndrome (npms), 24 Neurogenic thoracic outlet syndrome (NTOS) athletes diagnostic delay, 82 imaging evaluation, 83 NTOS symptoms, 81 pain, 82 physical examination, 81 predisposing activities, treatment and outcomes, unnecessary operative procedure, care-pathway and treatment options anterior scalene/pectoralis minor muscle blocks, center approach, complex regional pain syndrome, diagnosis, evaluation and management algorithm, 162 follow-up care, history, 158 medications, 163 occupational therapy, 161 pectoralis minor tenotomy, physical examination, 158 physical therapy, 161, 163 supraclavicular decompression, 162 cervical ribs anomalous first ribs, clinical presentation, 87 embryology, 85, 86 epidemiology, 87 pathophysiology, 87 physical therapy, plain radiograph and CT, 85, 86 surgical intervention, 88 chiropractic treatment bio-mechanical function, chronicity factor, 185 future aspects, 186 generic types, 184 manual challenge, 186 pectoral girdle evaluation, 184 proper function re-establishment, sterno-clavicular and acromioclavicular joint, 184 TOS and breathing mechanism, choice of operation brachial plexus, exploration and neurolysis, 285 LDM transfer flap, pectoralis minor tenotomy, 285

9 699 supraclavicular scalenectomy, 285 transaxillary and supraclavicular branchial plexus exploration, 286 transaxillary first rib resection, clinical diagnosis, clinical presentation CBSQ, 45, 46 DASH, 45 electromyography, 45 MRI scans, 45 neurological symptoms history, 42 pain radiation patterns, 44 positive clinical findings, 42 Tinel s sign, in clinical research diagnosis and functional assessment, etiology and pathophysiology, incidence of, 300 treatment approaches to, complementary and alternative medicine efficacy, 189 erythropoietin, 190 heparin, 190 hypnosis, 190 intraosseous blockade, 190 nalbuphine, 190 nitroglycerine, 190 octreotide, 190 pulsed high intensity magnetic stimulation, topical sphenopalatine ganglion blocks, 191 transcutaneous nerve stimulation, 191 vagal nerve stimulation, 191 complex regional pain syndrome brain plasticity, 196 central sensitization, 196 classification, 194 clinical features, 195 clinical signs, 193 differential diagnosis, 56 epidemiology, 195 historical perspectives, 194 local inflammation, 195 nerve injury, 193 neurogenic edema, 196 skin abnormalities, SNS response, 195 tissue trauma and local nerve injury, 195 treatment strategies, 196 computerized tomographic (CT) scanning, 308 congenital bands and ligaments, 36 consensus-based diagnostic criteria ( see Consensusbased diagnostic criteria) cost management, 273 CRPS (see Complex regional pain syndrome) depression, 273 diathesis-stress model, 278 DSM-IV-TR criteria, 278 treatments for, diagnosis and treatment of, 272 diagnostic tests EMG/NCV evaluation, imaging, 284 muscle blocks, 283 differential diagnosis, 282 carpal tunnel syndrome, cervical dystonia, 51 cervical spine disorders, chronic headache, 55 coexisting and complicating factors, complex regional pain syndrome, 56 depression, 56 fibromyalgia, musculoskeletal conditions, 52 myofascial pain, opioid hyperalgesia, 58 somatization and iatrogenicity, 56 ulnar entrapment syndrome, 52 53, 55 discharge activity, 243 follow-up, 243 oral pain medications, 243 physical therapy, 243 return to work, 243 double crush syndrome cubital tunnel syndrome, 103 diagnotic criteria, 103 provocative tests, 103 secondary compression, 103 surgical treatment, 104 electrodiagnostic study, electrophysiologic nerve testing abnormal ulnar nerve SSEP, 128 cervical root stimulation, conventional nerve conduction velocity study, 130 MACN testing, 129, 130 needle electrode examination, 130 reduced ulnar SNAP, 127 traditional method, 128 epidemiology, 32 ergonomic and postural abnormalities children, epidemiology, pathophysiology, 107 treatment options, etiology and types, 282 first rib resection advantage of sparing, scalene muscles, Gilliatt-Sumner hand anatomic considerations, 70 anterior supraclavicular approach, 70, 71 intraoperative nerve action potential, 70, 72 posterior subscapular approach, 70, 71 headaches, 312 histopathologic evaluation, 309 inflammation,

10 700 Neurogenic thoracic outlet syndrome (NTOS) ( cont.) long-term outcomes pattern of failure, 293, 294 quality of life, 294, 296 magnetic resonance (MR) imaging, 308 mechanical tension, 312 NCV, 232 noninvasive vascular laboratory evaluation, 308 non-operative treatment pain management regimens, 284 physical therapy, 284 workplace and lifestyle alterations, 284 NTOS-targeted therapy, 46 occupational therapy (see Occupational therapy (OT)) operating room, 240 operative technique muscle-splitting incision, 233 neurolysis, 234 patient positioning, 234 posterior superior serratus muscle resection, 234 results of, T2 and T3 ganglia dissection, 234 outcomes and assessment, 292 overdiagnosis/underdiagnosis, pain management (see also Neuropathic pain) complex regional pain syndrome, 266 deep brain stimulation, 264 intrathecal drug delivery, 265 ketamine infusions, motor cortex stimulation, 265 peripheral nerve stimulation, 264 spinal cord stimulation, pathology, 37 pathophysiology first rib resection, 38 non-traumatic onset, 39 post-traumatic onset, repetitive stress injury, 38 patient education, 273 pectoralis minor syndrome ( see Pectoralis minor syndrome) pectoralis minor tenotomy ( see Pectoralis minor tenotomy (PMT)) pediatrics anterior scalene muscle block, 76 chemodenervation, diagnostic approach, 76 pharmacological approach, 76 surgical decompression, TOS incidence, 75 pharmacological options for, 240, 241 physical examination, 283 physical therapist s evaluation ( see Physical therapist s evaluation) physical therapy, breathing dysfunction, 168 centralized nociceptive pain, 168 ENVEST protocol (see Edgelow neuro vascular entrapment syndrome treatment (ENVEST) protocol) loss of motor control, 168 plain radiography, 308 PMT, positional paresthesias carpal tunnel syndrome, 42 nocturnal numbness, 42 pulse obliteration with arm hyperabduction, 42 stress maneuvers, weakness and atrophy, hands, 45 post-anesthesia care unit (PACU), 240 post-discharge problems chest wall pain, 244 CRPS, 244 delayed recovery, 244 motor nerve dysfunction, 244 muscle soreness, 244 sensory nerve dysfunction, postoperative complications, 293 postoperative pain management anticonvulsants, 246 anti-depressants, 245 muscle relaxants, 245 narcotics, 245 NSAIDs, predisposing factors, 35 preoperative preparation, primary care and diagnosis clinical history, cross-sectional imaging, 34 diagnostic criteria, 32 nerve conduction studies, 34 physical examination, 33 referral, 34 specificity and accuracy, 32 supraclavicular tenderness, 33 psychiatric considerations depression, substance abuse, psychosocial factors, 272 radiographic imaging (see Radiographic imaging) recurrence of, 282 recurrent, 639 repetitive trauma disorders brachial plexus injury, carpal tunnel syndrome, 89 muscle degeneration and regeneration, 91 postural dysfunction and NTOS, 90 repetitive work injury, 312 scalene muscle variations, secondary NTOS, social support, 272 specialty-specific surgical principles, standard gray-scale ultrasonography, 308 supraclavicular approach (see Supraclavicular first rib resection) supraclavicular first rib resection pathophysiology of, 316 patient s presentation, 316 scalene muscle involvement, surgical floor activity, 242 anti-constipation medications, 243

11 anti-embolism protection, 242 diet, 242 drain management, 243 hygiene, 242 incentive spirometry, 242 local anesthetic infusion catheter, 243 nausea, 240 nurse monitoring, 242 pain management, 242 physical therapy, 242 supportive medication, surgical outcomes, surgical treatment, 285 symptoms and signs, 29 symptoms of, 282 transaxillary approach (see Transaxillary approach) transaxillary first rib resection pathophysiology of, 316 patient s presentation, 316 scalene muscle involvement, treatment, 30 work status, Neuropathic pain (NP) anticonvulsants, 255, 258 antidepressants selective serotonin reuptake inhibitors, 255 TCA, combination therapy, definition, 254 opioids, 258 pharmacological treatment, 254 topical agents, 258 Numeric pain rating scale (NPRS), 62 O Occupational therapy (OT) follow up, 180 post operative treatment exercise program, 179 initial post operative visit, 179 positioning recommendations, 179, 180 primary therapy ADL and IADL tasks analysis, education, 176 nerve glide handout, 176, 178 patient assessment, 176 sample intake form, scapular musculature strengthening, 176 treatment setting, Opioid hyperalgesia, 58 P Paget-Schroetter syndrome (PSS), 7, 493, 517, 529 Pain, nociceptive vs. neuropathic, 194 Paraclavicular approach, VTOS adjunctive arteriovenous fistula, 444 external subclavian venolysis and venography, 441 infraclavicular exposure, 437 inpatient physical therapy, patient preparation, postoperative care, 444 selection of, 434 subclavian vein exposure, 437, subclavian vein reconstruction, supraclavicular exposure, therapeutic anticoagulation, treatment goals, vein graft bypass, vein patch angioplasty, 441, 443 Pectoralis minor space, 18, 19 Pectoralis minor syndrome (PMS) clinical symptom, 94, 95 conservative treatment, 97 diagnostic tests electrodiagnostic testing, 97 selective muscle blocks, etiology, 94 neurogenic TOS, 96 physical examination, 94, 95 in recurrent neurogenic TOS, 100 surgery outcomes, 98, 100 pectoralis minor tenotomy (see Pectoralis minor tenotomy (PMT)) Pectoralis minor tenotomy (PMT), deltopectoral (anterior) approach blunt dissection, 219, 221 coracoid process, fascia incision, patient position, 219, 220 wound closure, 221 diagnosis and indications pectoralis minor muscle blocks, physical examination, 218, 219 followup care, 222 infraclavicular incision, 98 infraclavicular/subclavicular (anterior) approach, partial myomectomy, 98, 99 patient positioning, 97, 98 postoperative physical therapy, 98 supraclavicular scalene triangle, transaxillary (lateral) approach, 221 transaxillary technique, 98, 99 transverse incision, 97 Peripheral nerve stimulation, 264 Pharmacomechanical thrombolysis (PMT), Physical therapist s evaluation objective evaluation active movement and palpation tests, active movements, 62 postural observation/assessment, 62 subjective evaluation cardiovascular assessment, 64 functional assessment, 62 hand temperature, 63 history, 62 neurodynamic testing, numeric assessment, 62 Spurling s test, 63 strength testing, 64 67

12 702 Physical therapy breathing dysfunction, 168 centralized nociceptive pain, 168 ENVEST protocol breathing training, cardiovascular conditioning, core stabilizer activation, indications, 169 treatment progression, 173 loss of motor control, 168 motor vehicle accident, repetitive data entry, Pneumothorax, 463, 643 Posterior cord injury, 90 Prevenous phrenic nerve, 23 Proprioceptive neuromuscular facilitation (PNF), 66 Pulmonary embolism (PE), 464 Q Quality of life (QOL) research assessment, 656 intervention, 658 measurements, 656 mental component score, 659, 660 morbidity and mortality, 655 physical component score, 659, 660 pre-operative patient demographics, 658 rate of recovery, 658 theories, time course, 660 R Radiographic imaging dynamic changes coracoid process, 120 costoclavicular interval, 114, 115, 119 CT and MRI, 119 hyperabduction-external rotation, 119 prescalene space, 114 retropectoralis space, 114, 116, 119 scalene triangle, 114, 115, 119 MRI and CT, static pathology bony abnormalities, 116 brachial plexus abnormalities, 119 fibromuscular abnormalities, 117, 119 thoracic outlet brachial plexus, 114 costoclavicular interval, 112, 113 prescalene space, 114 retropectoralis space, 112, 114 scalene triangle, 112, 113 Reflex sympathetic dystrophy (RSD). See Complex regional pain syndrome Repetitive trauma disorders brachial plexus injury, carpal tunnel syndrome, 89 muscle degeneration and regeneration, 91 postural dysfunction and NTOS, 90 S Scalene muscles congenital anomalies, embryology, 14 Scalene test block dystonia, botulinum chemodenervation multiple site injections, muscle biopsy study, 139 neck and shoulder muscle pain, single site injections, 139 facet blocks, 138 multiple site injection double blinding, 135 fluoroscopic and EMG guidance, 134 intramuscular needle tip penetration, pain scale scoring, 136 ultrasound and EMG guidance, single site injection EMG guidance, 134 surface landmarks, 134 suprascapular and axillary blocks, 138 ultrasound guided brachial plexus blocks, 138 ultrasound guided stellate blocks, Society for vascular surgery website, 676 Society of thoracic surgeons (STS), Spinal cord stimulation, Straight leg raise (SLR), 63 Substance abuse, NTOS addiction, 279 opioids addiction, 279 physical dependence, 279 tolerance, 279 Supraclavicular first rib resection axillosubclavian artery, 598 minimizing scar tissue formation, 248 NTOS advantages, anterior scalenectomy, 211, 212 bone rongeur, posterior and anterior rib removal, 214 brachial plexus neurolysis and middle scalenectomy, clinical outcomes, closed-suction drain, 215 first rib resection, hyaluronidate-based absorbable film, 215 patient positioning, 210, 211 peripheral nerve stimulator, 210 phrenic nerve, 210 polylactide film, 215 preoperative preparation, 210 scalene fat pad, 210 scopolamine patch, 210 Stille-Gertz guillotine-type bone cutter, 214 transverse incision, 210

13 pathophysiology of, 316 patient s presentation, 316 pattern of breathing, 248 ratio of activity and rest, 251 scalene muscle involvement, scar mobilization breathing exercises, caudal, 248, 249 cephalad, 248, 250 left ULTT, 248, 249 ROM, VTOS, 386 Sympathectomy, 624 T Thoracic outlet anatomy anatomical spaces, brachial plexus, 21, 22 cervical and anomalous fi rst ribs, cervical sympathetic nerve chain, 22 dorsal scapular nerve, 22 ligaments and bands, 21 long thoracic nerve, phrenic nerve, 21 scalene and pectoralis minor muscles, 123 scalene triangle, 17 subclavian and axillary vessels, 23 thoracic duct, 24 embryology cervical ribs (see Cervical ribs) neurovascular development, 12 scalene muscles, 14 lateral view, 11, 12 Thoracic outlet syndrome (TOS) arterial occlusion, 7 ATOS (see Arterial thoracic outlet syndrome) clinic advantages, 686 first visit, 688 follow up visit, 689 personnel, physical plant and resources, prior to visit, 688 resources testing, 688 concentration of resources, electrophysiologic test, 6 first rib resection era, 6 7 historical evolution cervical rib, 4 5 medical diagnosis, 4 incidence and prevalence anatomic and electrophysiologic findings, 26 medical office workers, morbidity and mortality, 27 neurogenic TOS, 26, 27 nonspecific NTOS, 26 overuse injury, 26 predisposing anatomic factors, 26 surgery, 26 United States, 27 vascular TOS, 25 work-related injury, 26 NTOS (see Neurogenic thoracic outlet syndrome) patient chart, 684 scalenectomy era anatomic variations, 5 cervical rib syndrome, 5 histochemistry and fi ber type analysis, 4 scalene muscle, 5 venous abnormality, 7 8 VTOS (see Venous thoracic outlet syndrome) Thrombolysis angioplasty, PMT, pre thrombolysis left subclavian venogram, 416 results, venogram, 414 Tinel s sign, Tinel s tap test, 63 Transaxillary approach brachial plexus injury, exposure anterior scalene muscle, 204, 205 cerebellar/weitlaner retractors, 202 Cobb periosteal elevator, 204 deep wound retraction, 203 periodic breaks, 204 right-sided thoracic outlet anatomy, 202 soft issue separation, 203 transverse skin line incision, 202 patient positioning, 202 postoperative care, 207 postoperative complications nerve injury, 208 pneumothorax, 208 TOS recurrence, 208 vascular injury, preoperative physical therapy, prophylactic antibiotics, 202 rib resection, wound closure, Transaxillary first rib resection pathophysiology of, 316 patient s presentation, 316 scalene muscle involvement, U Ulnar entrapment syndrome, 52 53, 55 Ulnar innervated thumb muscles strength assessment, 66 Unilateral digital ischemia aneurysmal degeneration, 559, 561 catheter-based selective arteriography, 559 differential diagnosis, 558, 559 digital artery thrombosis, 559 digital ulceration, 557, 558

14 704 Unilateral digital ischemia ( cont.) hypothenar hammer syndrome, 559 physical examination, 557 primary digital artery spasm, 559 primary vasospasm, 558, 559 subclavian artery aneurysm, 559, 560 symptoms, 557 thrombolytic and vasodilator agents, 562 treatment, 559, 562 V Vascular injuries, Vasospasm, 558, 559 Vein patch angioplasty, 441, 443 Venoplasty, 485, 486 Venous thoracic outlet syndrome (VTOS) acquired veno-compressive condition, 462 acute axillosubclavian vein thrombosis anticoagulation, 384 thrombolysis, 384 acute effort thrombosis, 509 acute thrombus management, 392 acute VTOS, treatments outcomes, 485, 487 anatomy of, , 346 anticoagulant therapy, 509 anticoagulation, , 472 axillo-subclavian vein thrombosis, chest guidelines, 532 exogenous steroids, 533 goals, hypercoagulable conditions, 533 venography, ASCV, competitive athletes anticoagulation, 366 clinical presentation, 366 diagnosis and initial treatment, 366 surgical treatment, AVF, balloon angioplasty, 511 bilateral, 638 bypass procedures, 515 catheter-directed thrombolysis, 509, 510, 529 chronic thrombus management, 392 chronic VTOS, treatments outcomes, 487, 488 classification scheme, claviculectomy, 452 clinical outcomes, , clinical pathways, 472 clinical presentation, acute upper extremity venous thrombosis, 380 chronic venous occlusion, 381 post-phlebitic stenosis, clinical scenarios, clot dissolution, 509 computed tomographic imaging advantages of, 373 arterial phase image, 372 limitation of, non-ionic intravenous contrast, 372 patient positioning, 372 subclavian vein or artery, 372 venous phase image, 372 contemporary management, 513 contralateral side, costoclavicular space decompression, CT and MR, 414 CVO (see Central venous obstruction) decision-making process, 522, 523 decompressive surgery, definition of, diagnostic testing, 337, differential diagnosis of arteriovenous fistula/graft (AVF/AVG), chronic post phlebitic syndrome, 383 Klippel-Trenaunay-Weber syndrome (KTS), 382 lymphedema, 383 Paget-Schoroetter syndrome, pancoast tumors, 382 duplex ultrasound, DVT, 462 endovenectomy, 454 evidence-based data, 503 external venolysis, 510 extrinsic venous compression, 513 fi rst rib resection, 485, 487, grading system, 504, 505 history of, 335 Hopkins protocol, infraclavicular approach clinical outcomes, general endotracheal anesthesia, 430 pectoralis major muscle, 430 postoperative management, 431 residual stenosis, balloon angioplasty, 430, 431 subclavian venolysis, 430, 431 transverse incision, 430 infraclavicular incision, 452 initial evaluation, , initial treatment, initial treatment options, 493, 494 institutional review, 472 institutional treatment algorithms, 473, 485 intermittent positional obstruction, 538 interposition graft, 453 intervention/procedure, ipsilateral autogenous venous reconstruction, 514 IVUS, 528 jugular turndown, magnetic resonance imaging advantages of, limitations of, technique, medial claviculectomy axillary-subclavian-innominate vein, 448 clavicle incision, 447 oscillating saw, 448

15 705 periosteal elevator, results, modern literatures, 472, paraclavicular approach adjunctive arteriovenous fistula, 444 external subclavian venolysis and venography, 441 infraclavicular exposure, 437 inpatient physical therapy, 445 patient preparation, postoperative care, 444 selection of, 434 subclavian vein exposure, 437, subclavian vein reconstruction, supraclavicular exposure, therapeutic anticoagulation, treatment goals, vein graft bypass, vein patch angioplasty, 441, 443 pathophysiology, 341 patients categories, 522 patient with diseased vein, patient with normal vein, 522 patient with occluded vein, pediatric age group catheter-directed thrombolysis, 362 hypercoagulability, 362 male and female ratio, 362 musculoskeletal abnormalities, 362 prevalence of, 362 primary thrombosis, 361 persistent/recurrent clinical characterization, 493, 494 evaluation and treatment options, 495 persistent venous TOS, preoperative delineation, 497 primary neurogenic TOS, recurrent venous TOS, reoperation, secondary neurogenic TOS, symptoms, pharmacomechanical devices Amplatz thrombectomy device, percutaneous thrombectomy device, 417 Trellis catheter, physical examination, planar radiographic imaging, 462 postoperative care complications, follow-up care, in-hospital care, occupational therapy, 468 physical therapy, 469 residual subclavian vein obstruction, 467 strengthening exercises, 469 subclavian vein patency, temporary arterio-venous fistulas, 467 pre-decompression catheter-directed interventions, 473, preoperative evaluation, 453 prevalence of, 391 primary surgical goal, primary types and characteristics, 504 PTVA + stent, 342 randomized control trials, 506 replacement graft, 454 reporting standards, results evaluation, 342 rib resection, stenosis, stents, sternal split, subclavian endovenectomy, 453 subtotal thoracic outlet decompression, 393 surgery, 638 symptoms of, thrombolysis angioplasty, PMT, pre thrombolysis left subclavian venogram, 416 results, venogram, 414 thrombophilia, transaxillary first rib resection anterior scalene muscle insertion, 425, 426 arm elevation, 424, 425 complications, external venolysis and subtotal mobilization, 426, 427 general anesthesia, 424 pre and postoperative venograms, 426, 427 UCLA, 424, 425 Weitlander retractors, 424 wrapping, 424, 425 treatment, treatment algorithm, 488, 489 treatment progression, venography, 393 venoplasty, 485, 486 venous reconstruction, 485, 487 incision, 452 indications, venous stents, 485, 486 Visual analogue pain scores (VAS), 139 W Wikipedia, 678 Workers compensation CTS, 670 health benefits, 670 non-catastrophic injury, 669 observational studies, time loss and medical costs, 671 wage loss compensation, 670 Washington workers compensation,