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Thoracic outlet syndromes (TOS)

Sist oppdatert: Sist revidert:
Sist revidert av:

Definisjon:
En gruppe etiologisk og klinisk distinkte forstyrrelser som skyldes kompresjon av en eller flere nevrovaskulære elementer idet de passerer ut av thoraxhulen
Forekomst:
Sjelden, men er sannsynligvis underdiagnostisert
Symptomer:
Vanlige symptomer er smerter, nummenhet, parestesier, svekket kraft og tyngdefølelse i den involverte overekstremiteten
Funn:
Mulige kliniske funn kan være nakkesmerter som forverres ved bruk av elevert arm, parestesier tilsvarende segmentene C8-Th1, ømhet over plexus brachialis supraklavikulært, positiv Roos' test
Diagnostikk:
Bildediagnostikk er ikke pålitelig. Elektrofysiologiske undersøkelser kan være nyttige
Behandling:
Konservativ behandling med øvelser hos fysioterapeut anbefales primært og angis å gi gode resultater hos 80%. Kirurgi gir dårlige resultater
  1. Goshima K. Overview of thoracic outlet syndromes. UpToDate, last updated Jan 31, 2019. UpToDate  
  2. Kuhn JE, Lebus V GF, Bible JE. Thoracic outlet syndrome. J Am Acad Orthop Surg. 2015 Apr;23(4):222-32. doi: 10.5435/JAAOS-D-13-00215 DOI  
  3. Rosenbaum DA. Thoracic Outlet Syndrome. Medscape, last updated Jan 10, 2019. emedicine.medscape.com  
  4. Hong J, Pisapia JM, Ali ZS, et al. Long-term outcomes after surgical treatment of pediatric neurogenic thoracic outlet syndrome. J Neurosurg Pediatr 2018; 21:54. PubMed  
  5. Moore R, Wei Lum Y. Venous thoracic outlet syndrome. Vasc Med. 2015;20:182-9. doi: 10.1177/1358863X14568704 DOI  
  6. Ferrante MA, Ferrante ND. The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome. Muscle Nerve. 2017 Jun;55(6):782-793 . pmid:28006844 PubMed  
  7. Ferrante MA, Ferrante ND. The thoracic outlet syndromes: Part 2. The arterial, venous, neurovascular, and disputed thoracic outlet syndromes. Muscle Nerve. 2017 Oct;56(4):663-673 . pmid:28006856. PubMed  
  8. Orlando MS, Likes KC, Mirza S, et al. A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome. J Am Coll Surg 2015; 220:934. PMID: 25840533 PubMed  
  9. Urschel HC, Kourlis H. Thoracic outlet syndrome: a 50-year experience at Baylor University Medical Center. Proc (Bayl Univ Med Cent). 2007;20:125-135. PubMed  
  10. Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vasc Surg 2007; 46:601. PubMed  
  11. Stewman C, Vitanzo PC Jr, Harwood MI. Neurologic thoracic outlet syndrome: summarizing a complex history and evolution. Curr Sports Med Rep. 2014;13:100-106. PubMed  
  12. Machanic BI, Sanders RJ. Medial antebrachial cutaneous nerve measurements to diagnose neurogenic thoracic outlet syndrome. Ann Vasc Surg. 2008;22:248-254. PubMed  
  13. Povlsen B, Hansson T, Povlsen SD. Treatment for thoracic outlet syndrome. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD007218. DOI: 10.1002/14651858.CD007218.pub3. DOI  
  14. Lo CNC, Bukry SA, Alsuleman S, et al. Systematic review: the effectiveness of physical treatments on thoracic outlet syndrome in reducing clinical symptoms. Hong Kong Physiother J. 2011;29:53-63. PubMed  
  15. Stewman C, Vitanzo PC, Harwood MI, Beredjiklian PK. Thoracic outlet syndrome. BestPractice, last updated Mar 2018.
  16. Peek J, Vos CG, Ünlü Ç, et al. Outcome of Surgical Treatment for Thoracic Outlet Syndrome: Systematic Review and Meta-Analysis. Ann Vasc Surg 2017; 40:303. PubMed  
  17. Ferrante MA. The thoracic outlet syndromes. Muscle Nerve. 2012;45:780-795. PubMed  
  18. Sanders RJ, Hammond SL, Rao NM. Thoracic outlet syndrome: a review. Neurologist. 2008;14:365-373. PubMed  
  19. Sucher BM. Ultrasonography-guided osteopathic manipulative treatment for a patient with thoracic outlet syndrome. J Am Osteopath Assoc. 2011 Sep. 111(9):543-7.
  20. Green RM, McNamara J, Ouriel K: Long-term follow-up after thoracic outlet decompression: an analysis of factors determining outcome. J Vasc Surg 1991; 14: 739-45. PubMed  
  21. Lindgren KA, Oksala I: Long-term outcome of surgery for thoracic outlet syndrome. Am J Surg 1995; 169: 358-60. PubMed  
  • Terje Johannessen, professor i allmennmedisin, Trondheim (tilpasning til NEL)

Tidligere fagmedarbeidere

  • Pål Kristensen, spesialist i allmennmedisin, Ranheim legesenter, Trondheim