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Physiotherapy of Thoracic Outlet
Saloua Khalfaoui, Abdellah El Marbouh, El Mustapha El Abbassi
Open Access Library Journal (OALib Journal) , 2019, DOI: 10.4236/oalib.1105350
The thoracic outlet syndrome is a pathology due to the compression of the vasculo-nervous package arising in the cervico-scapulo-thoracic area. The functional signs, the clinical picture as well as the complication can in some cases be a diagnostic and therapeutic problem from the necessity of a careful dismemberment of this pathology before establishing an adapted and specific protocol of reeducation. The main purpose of the coverage of this entity is to avoid the recurrence, to improve the quality of the treatment as well as the quality of life.
Impedance plethysmographic observations in thoracic outlet syndrome.  [cached]
Nerurkar S,Jindal G,Pedhenekar S,Gupta D
Journal of Postgraduate Medicine , 1990,
Abstract: Forty patients with symptoms of neuro-vascular compression in the upper extremities were subjected to impedance plethysmographic study using Parulkar′s method. Two patients recorded decreased blood flow (BFI) in supine position and were diagnosed as having partial occlusion at subclavian level. Sixteen of the patients recorded decreased BFI on 90 degrees abduction and hyper-abduction. Twelve of these patients had radiological evidence of anomalous cervicle ribs. In remaining four patients extrinsic impression on the subclavian artery due to fibrous deposits was confirmed by arteriography. Remaining 22 patients recorded normal impedance plethysmograms. Impedance plethysmography thus provided a non-invasive modality for confirmation of vascular compression in thoracic outlet syndrome.
A Synthesis of Software Evaluation Methodologies and the Proposal of a New Practical Approach  [cached]
Armin Azarian,Ali Siadat
Journal of Software , 2011, DOI: 10.4304/jsw.6.11.2271-2281
Abstract: A large number of developed, acquired or purchased software tools do not respond to the users’ requirements and expectations which had often been at the origin of the project. This is mainly due to two reasons: firstly because the users’ requirements are not well identified or formalized as they should, secondly because the software and tool evaluation is not robust enough or does not have a minimum required quality [1]. We attempt to propose a new approach in order to assess and quantify the quality of the software evaluation process. The theoretical approach is based on elaborating a matrix (An,m) of software functionalities versus user’s scenarios. The norm of the columns and lines vectors of this matrix may be considered as a quality indicator of the process. Performance metrics are also derived from such indicators to summarize the quality of software evaluation process from the users’ point of view. We have applied such an approach on one case study and derived indicators like task effectiveness and efficiency of the software product evaluation. This method helps in two stages of the development cycle of the software: during the design phase and during the verification and validation. The case study helps to identify software imperfections and insufficiencies in a practical manner early in the development lifecycle. Thus improving subsequent releases of the software product.
Zur Problematik des Thoracic Outlet-Syndroms  [PDF]
Mamoli B
Journal für Neurologie, Neurochirurgie und Psychiatrie , 2008,
Abstract: Das Thoracic Outlet-Syndrom (TOS) ist ein u erst kontrovers diskutiertes Engpasssyndrom, das für ca. 4 % aller nicht-traumatischen Paresen des Plexus brachialis verantwortlich ist [1]. Nach Wilbourn [2] wird zwischen einem neurogenen TOS (klassisches TOS) und einem fraglichen (disputed TOS) differenziert. Aus pathophysiologischer Sicht wird ein neurogenes (ca. 90 % aller TOS), ein arterielles und ein ven ses TOS differenziert [3, 4]. Die einzelnen Formen k nnen aufgrund unterschiedlicher Symptome gut voneinander abgegrenzt werden. H ufigste Ursachen sind abnorme anatomische Strukturen (fibr se B nder etc.) oder über Jahre ausgeübte muskul re T tigkeiten (z. B. Sportler, Musiker). Zur Diagnose werden klinische, lektrophysiologische, radiologische und Neuroimaging-Verfahren herangezogen. Wenngleich die neuen Techniken wie MRT, MRA und Sonographie die diagnostische Sicherheit erh ht haben, hnelt die Diagnose eines TOS einem Indizienprozess und erfordert eine sorgf ltige Analyse aller Daten. Therapeutisch ist bis heute der Wert der konservativen Therapie nicht durch kontrollierte Studien belegt. Die Therapieans tze basieren auf pathophysiologischen überlegungen. W hrend beim vaskul ren TOS ein rasches chirurgisches Eingreifen erforderlich ist, sollte beim neurogenen TOS, au er bei Progredienz der Symptomatik, zun chst ein konservativer Therapieversuch unternommen werden.
Proposal of a new method for effectiveness evaluation in the product design and development process
Caminada Netto, Adherbal;Kaminski, Paulo Carlos;
Produ??o , 2011, DOI: 10.1590/S0103-65132011005000034
Abstract: this paper addresses the subject of product design process evaluation from the designer's point of view. based on the results of a preliminary research phase a comprehensive questionnaire is drawn up, and applied to a selected group of designers in the automotive industry, comprising brazilian plants of two major car manufacturers, two tier 1 suppliers and one lorry and bus manufacturer. data provided by the answers are compiled, presented and discussed within each organizational environment. a combined analysis is then carried out in order to identify those management actions that are considered by the automotive industry as being more important for both assuring and evaluating the effectiveness of the product design and development process. management actions are classified according to criteria supplied by the iso quality management standards. finally, based on the evaluation, management action indicators are defined and a single and flexible effectiveness index is proposed, which can be calculated using both company and industry data for evaluation and benchmark purposes.
Isolated Cervical Rib Fracture: A Rare Etiology of Thoracic Outlet Syndrome
Rayees Ahmad Dar,Sabiya Hamid Wani,Majid Mushtaque
Case Reports in Surgery , 2011, DOI: 10.1155/2011/163792
Abstract: Isolated fracture of a cervical rib is a very rare entity and usually presents as a painless swelling or as thoracic outlet syndrome. We describe a case of a 45-year-old woman with history of fall two months back. She presented with symptoms of neurogenic thoracic outlet syndrome for one month. Isolated left cervical rib fracture was documented on X-ray cervical spine. Her fractured cervical rib was resected through a supraclavicular approach, and symptoms resolved completely in the postoperative period.
Unusual thoracic outlet syndrome secondary to bullet lodge in brachial plexus
Iseri PK,Budak F
Journal of Neurological Sciences , 2004,
Abstract: The cause of thoracic outlet syndrome (TOS) is multifactorial, and includes anatomical anomalies and trauma. Most traumatic brachial plexopaties have an immediate onset; however, some may occur with such delayed onset that the original event is overlooked. We report a case of post-traumatic delayed onset TOS due to a bullet lodge to left brachial plexus.
Early versus Late Surgical Treatment for Neurogenic Thoracic Outlet Syndrome  [PDF]
Jasem Yousef Al-Hashel,Ashraf Ali M. A. El Shorbgy,Samar Farouk Ahmed,Rawhia R. Elshereef
ISRN Neurology , 2013, DOI: 10.1155/2013/673020
Abstract: Objectives. To compare the outcome of early surgical intervention versus late surgical treatment in cases of neurogenic thoracic outlet syndrome (NTOS). Design. Prospective study. Settings. Secondary care (Al-Minia University Hospital, Egypt) from 2007 to 2010. Participants. Thirty-five patients of NTOS (25 women and 10 men, aged 20–52 years), were classified into 2 groups. First group (20 patients) was operated within 3 months of the onset and the second group (15 patients) was operated 6 months after physiotherapy. Interventions. All patients were operated via supraclavicular surgical approach. Outcomes Measures. Both groups were evaluated clinically and, neurophysiologically and answered the disabilities of the arm, shoulder, and hand (DASH) questionnaire preoperatively and 6 months after the surgery. Results. Paraesthesia, pain, and sensory nerve action potential (SNAP) of ulnar nerve were significantly improved in group one. Muscle weakness and denervation in electromyography EMG were less frequent in group one. The postoperative DASH score improved in both groups but it was less significant in group two ( in group 1 and in group 2). Conclusions. Surgical treatment of NTOS improves functional disability and stop degeneration of the nerves. Early surgical treatment decreases the occurrence of muscle wasting and denervation of nerves compared to late surgery. 1. Introduction Thoracic outlet syndrome (TOS) is defined as a group of clinical symptoms caused by the entrapment of neurovascular structures (subclavian vessels and the brachial plexus) en route to the upper limb via the superior thoracic outlet [1]. This is generally due to a congenital bony anomaly either because of the presence of a cervical rib, a prolongation of the C7 transverse process, or being secondary to fibrous bands or anomalous muscles [2]. Also, trauma such as hyperextension-flexion injuries of arm, neck trauma due to motor vehicle accidents, repetitive stress injury, and trauma that causes chronic cervical muscle spasm may precipitate NTOS [3, 4]. Most of the patients 95% have a neurogenic form, 2% have venous symptoms and only 1% has clinical arterial compression [5]. The diagnosis of neurogenic TOS is relatively straightforward. It is presented with pain and sensory disturbance predominantly in the ulnar forearm and hand, aggravated by use of the affected limb. Weakness and wasting of the small hand muscles are also reported. Neurophysiological studies confirming chronic postganglionic axonal loss, and excluding focal mono-neuropathy [6]. Surgical management is controversial
Neurogenic thoracic outlet syndrome: A case report and review of the literature  [cached]
Boezaart André,Haller Allison,Laduzenski Sarah,Koyyalamudi Veerandra
International Journal of Shoulder Surgery , 2010,
Abstract: Neurogenic thoracic outlet syndrome (NTOS) is an oft-overlooked and obscure cause of shoulder pain, which regularly presents to the office of shoulder surgeons and pain specialist. With this paper we present an otherwise healthy young female patient with typical NTOS. She first received repeated conservative treatments with 60 units of botulinium toxin injected into the anterior scalene muscle at three-month intervals, which providing excellent results of symptom-free periods. Later a trans-axillary first rib resection provided semi-permanent relief. The patient was followed for 10 years after which time the symptoms reappeared. We review the literature and elaborate on the anatomy, sonoanatomy, etiology and characteristics, symptoms, diagnostic criteria and treatment modalities of NTOS. Patients with NTOS often get operated upon - even if just a diagnostic arthroscopy, and an interscalene or other brachial plexus block may be performed. This might put the patient in jeopardy of permanent nerve injury, and the purpose of this review is to minimize or prevent this.
Diagnostic Values of Clinical Diagnostic Tests in Thoracic Outlet Syndrome - Original Article  [cached]
Mustafa ?al??,Mehmet Altuncuo?lu,Ay?in Demirel
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2010,
Abstract: Objective: The aim of this study was to demonstrate the diagnostic values of clinical diagnostic tests for thoracic outlet syndrome (TOS).Materials and Methods: The study was performed on 135 patients who had neck and arm pain. Of these patients, 93 had TOS and 42 had diseases other than TOS. Two blinded investigators performed the Adson’s test, costoclavicular test, Roos test, supraclavicular Tinel’s sign, Halstead’s maneuver, hyperabduction test and the Allen’s test, which are special diagnostic methods used in TOS. The sensitivity, specificity, accuracy, and the positive and negative predictive values of these tests were calculated.Results: The sensitivities of clinical diagnostic tests found by the first investigator given in decreasing order are as follows: 92.47% for the Roos test, 74.19% for the Halstead’s maneuver, and 67.74% for the supraclavicular Tinel’s sign; the results of the second investigator were: 92.47% Roos test, 76.34% Halstead’s maneuver and 67.74% costoclavicular test. Regarding combination of tests, the highest sensitivity rates calculated using at least two tests were 90.44% and 90.74% estimated by the first and the second investigator, respectively.Conclusion: This study demonstrated that the most sensitive tests in the diagnosis of TOS are the Roos test, Halstead’s maneuver, supraclavicular Tinel’s sign and the costoclavicular test. Turk J Phys Med Rehab 2010;56:155-60.
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