• Journal of Chest Surgery
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• 제40권6호
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• pp.463-466
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• 2007

21세 남자 환자가 우측 손의 통증, 부종 및 저린감을 주소로 내원하였다. 정맥 조영술 및 MRI scan으로 Paget-Schroetter syndrome으로 진단되었으며, 혈전 용해술을 시행하였으나 호전이 없어 흉강경하에 1번 늑골 절제술을 시행하였다. 환자는 수술 후 증상이 호전되었으며, warfarin 처방과 함께 퇴원하였다. 통상적으로 알려진 1번 늑골 절제법은 경액와 접근법(transaxillary) 혹은 쇄골상부 접근법(supra-clavivular)등이 있으나, 본 증례의 경우 흉강경하에 1번 늑골 절제술을 시행하였고 이에 결과를 보고하는 바이다.

• Archives of Reconstructive Microsurgery
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• 제20권2호
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• pp.102-107
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• 2011

Purpose: As clinical manifestations of thoracic outlet syndrome are vague pain or symptoms in upper extremity, the diagnosis of the disease is delayed or misdiagnosed as cervical HNP, shoulder pathologies, or peripheral neuropathies. In that reason, many patients spend time for unnecessary or ineffective treatments. We report the results of our thoracic outlet syndrome cases, which were treated by conservative care or surgical treatment. Materials & Methods: Twenty five cases, diagnosed as thoracic outlet syndrome since 1999, were reviewed retrospectively. Physical examinations including Adson's and reverse Adson's test, hyperabduction test, costoclavicular maneuver, and Roo's test, plain radiography of shoulder and cervical spine, MRI of neck or brachial plexus, and EMG were checked. If subjective symptoms were not improved after conservative treatments over three months, surgical treatment were performed. Nine patients were performed operative treatment and the others had conservative treatment in outpatient clinic. Postoperative improvement of symptoms and the follow up period, and the results of conservative care were reviewed. Results: Among five physical examinations, mean 1.75 tests were positive, and EMG has little diagnostic value. MRI were performed in twenty cases and compression of brachial plexus were found in 6 cases (30%). Ten patients out of 16 conservative treatment group had excellent improvement of symptoms, and 5 had good results. Eight patients out of 9 operative treatment group had excellent improvement with mean 5.1 months of follow-up period. Conclusion: Diagnosis of thoracic outlet syndrome is difficult due to bizarre and vague symptoms. However if the diagnosis is suspected by careful physical examinations, radiologic studies, or nerve conduction studies, conservative care should be done as initial treatment and at least after three months, reassess the patient's condition. If the results of conservative treatment is not satisfactory and still the thoracic outlet syndrome is suspected, surgical treatment should be considered. Conservative treatment and operative technique are the valuable for the treatment of this disease.

• Journal of Acupuncture Research
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• 제31권2호
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• pp.173-182
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• 2014

Objectives : There are few reports on treatment of thoracic outlet syndrome in the field of traditional Korean medicine. The aim of this study is to report a case of a 29-year-old male patient diagnosed with thoracic outlet syndrome, whose symptoms were relieved after 3-week integrated Korean medical treatment. Methods : A patient diagnosed with thoracic outlet syndrome was admitted into the Korean medicine hospital. The patient had left shoulder pain and left arm numbness. The pain was worse if it had become cold. The patient was treated using Sa-am acupuncture(Daejangseunggyeok), sweet bee venom acupuncture, herbal medicine and other treatment including physical therapy from September 7th to 27th of 2012. Improvement of the patient's symptoms was evaluated by verbal numerical rating scale(VNRS), skin surface temperature difference between the left and right symmetric part of digital infrared thermographic image(DITI). Results : After 3-weeks of treatment, VNRS decreased and skin surface temperature difference between the left and right symmetric part of DITI showed moderate improvement. Conclusions : The results suggest that integrated Korean medical treatment may affect to reduce the symptoms of thoracic outlet syndrome. Further study is needed to evaluate the importance of this report.

• The Korean Journal of Pain
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• 제13권1호
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• pp.97-100
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• 2000

Thoracic outlet syndrome (TOS) is a combination of signs and symptoms caused by the compression of the vital neurovascular structure at the thoracic outlet region. It may stem from a number of abnormalities, including degenerative or bony disorders, trauma to cervical spine, fibromuscular bands, vascular abnormalities and spasm of the anterior scalene muscle. CPT (current perception threshold) is defined as the minimum amount of current applied transcutaneously that an individual consciously perceives. It enables quantification of the hyperesthesia that precedes progressive nerve impairment, as well as hypoesthetic conditions. We experienced a case of thoracic outlet syndrome caused by fibrosis of anterior scalene muscle. The patient was a 30 years old woman with a 3 years history of numbness on the ulnar side, progressive weakness and coldness of both hand, tiredness in the left arm, nocturnal pain in the left forearm, and pain in the left elbow, shoulder and neck. Conservative treatment, stellate ganglion block, cervical epidural block, anterior scalene block and previous operation, including both carpal tunnel release, provided no remarkable relief to the patient. A left scalenectomy and first rib resection were performed by transaxillary approach and left cervical root neurolysis was done. After surgery, we measured CPT using neurometer and found conditions worsening in the opposite arm. We performed the same procedure on right side, and followed by CPT measurement. This case suggests that CPT is a useful measurement of recovery and progression of TOS.

• 대한약침학회지
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• 제13권2호
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• pp.85-92
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• 2010

Objectives: The objective of this study was to compare the effects of Sweet Bee Venom(Sweet BV) Therapy between the hand paresthesia patients with Osteoporosis and without Osteoporosis. Methods: This study was carried out to established the clinical criteria of hand parethesia. The patients who had past history of diabeics, neuropathy induced by alcohol or drug and was positive on Myofacial Pain Syndrome Theory were excluded. 32 patients who had hand paresthesia related with unknown-reason was selected by the interview process. And the effects of treatment were analyzed using VAS score before treatment, after treatment, after 1 month and after 3 months. Results and conclusion: After treatment, While Osteoporosis group decrease from $64.81{\pm}7.81$ to $27.21{\pm}7.32$, Non-Osteoporosis group decrease from $58.76{\pm}1.43$ to $24.74{\pm}3.81$ by VAS scores. and After 3 months, While Osteoporosis group increase from $27.21{\pm}7.32$ to $54.96{\pm}9.40$, Non Osteoporosis group increase from $24.74{\pm}3.81$ to $32.43{\pm}5.57$. Non-Osteoporosis group was accordingly more effective than Osteoporosis group after 3 months. So Sweet BV therapy for hand numbness patients without Osteoporosis was e effective than patients with Osteoporosis.

• 대한정형도수물리치료학회지
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• 제9권2호
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• pp.5-11
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• 2003

Thoracic outlet syndrome is actually a collection of syndromes brought about by abnormal compression of the neurovascular bundle by bony, ligamentous or muscular obstacles between the cervical spine and the lower border of the axilla. First of all a syndrome is defined as a group of signs and symptoms that collectively characterize or indicate a particular disease or abnormal condition. The neurovascular bundle which can suffer compression consists of the brachial plexus plus the C8 and T1 nerve roots and the subclavian artery and vein. The brachial plexus is the network of motor and sensory nerves which innervate the arm, the hand, and the region of the shoulder girdle. The vascular component of the bundle, the subclavian artery and vein transport blood to and from the arm. the hand. the shoulder girdle and the regions of the neck and head. The bony, ligamentous, and muscular obstacles all define the cervicoaxillary canal or the thoracic outlet and its course from the base of the neck to the axilla or arm pit. Look at the scheme of this region and it all becomes more easily understood. Compression occurs when the size and shape of the thoracic outlet is altered. The outlet can be altered by exercise, trauma, pregnancy, a congenital anomaly, an exostosis, postural weakness or changes. Thoracic outlet syndrome has been described as occurring in a diverse population. It is most often the result of poor or strenuous posture but can also result from trauma or constant muscle tension in the shoulder girdle. The first step to beginning any treatment begins with a trip to the doctor. Make a list of all of the symptoms which seem to be present even if the sensations are vague. Make a note of what activities and positions produce or alleviate the symptoms and the time of day when symptoms are worst. Also, note when the symptoms first appeared. This list is important and should also include any questions one may have.

• 한방재활의학과학회지
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• 제32권4호
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• pp.89-96
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• 2022

The purpose of this study is to report the effects of Korean medicine treatment in wrist drop patient with thoracic outlet syndrome. We treated the patient for 8 days using Korean medicine treatment such as herbal medicine, acupuncture, Chuna manual therapy and pharmacopuncture. Changes in the numerical rating scale (NRS), EuroQol five dimension (EQ-5D) index, and symptoms were measured for assessment. After 8 days hospitalization, NRS decreased from 5 to 3, EQ-5D index and the symptoms of the patient also were improved. In conclusion, this case shows that Korean medicine treatment can be an effective treatment for wrist drop with thoracic outlet syndrome.