• 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.

• Journal of Chest Surgery
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• 제29권10호
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• pp.1160-1165
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• 1996

저자들은 지금까지 발생보고 예가 없는 좌쇄골하동맥 맥관육종 1례 수술을 치험하였다. 제 1늑골의 기형이 있는 19세 여자 환자로, 1년 전부터 점진적으로 심해진 동맥 흉곽 출구 증후군의 증상을 나타냈다. 쇄골 중앙부를 절제한 후 폐쇄된 쇄골하 동맥 제 3부분과 상완 동맥 분절을 절제하고 대복재 정맥을 이용하여 우회로 조성술을 시행하였다. 쇄골하 동맥의 병리 조직 소견은 벽재성형 맥관 육종이었으며 혈액 응고 인자 WII과 관련되는 항원에 대한 조직 화학적 염색 소견도 양성이었다. 수술전 일상 생활을 할 수 없을 정도 심한 증상이 수술후 거의 소실되었으며, 수술후 4개월된 현재 직장 생활을 계속하고 있다.

• 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.

• Journal of Chest Surgery
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• 제50권1호
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• pp.36-40
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• 2017

Background: Surgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In this study, we have compared the complications arising during the supraclavicular and the transaxillary approaches to determine the appropriate approach for TOS surgery. Methods: In this study, 448 patients with symptoms of TOS were assessed. The male-to-female ratio was approximately 1:4, and the mean age was 34.5 years. Overall, 102 operations were performed, including unilateral, bilateral, and reoperations, and the patients were retrospectively evaluated. Of the 102 patients, 63 underwent the supraclavicular approach, 32 underwent the transaxillary approach, and 7 underwent the transaxillary approach followed by the supraclavicular approach. Complications were evaluated over 24 months. Results: The prevalence of pneumothorax, hemothorax, and vessel injuries in the transaxillary and the supraclavicular approaches was equal. We found more permanent and transient brachial plexus injuries in the case of the transaxillary approach than in the case of the supraclavicular approach, but the difference was not statistically significant. Persistent pain and symptoms were significantly more common in patients who underwent the transaxillary approach (p<0.05). Conclusion: The supraclavicular approach seems to be the more effective technique of the two because it offers the surgeon better access to the brachial plexus and a direct view. This approach for a TOS operation offers a better surgical outcome and lower reoperation rates than the transaxillary method. Our results showed the supraclavicular approach to be the preferred method for TOS operations.

• 대한정형도수물리치료학회지
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• 제3권1호
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• pp.17-27
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• 1997

The PT program provides relief to most patients with symptom of TOS. So the purpose of our study is to evaluate a effects of PT program in patients with TOS. PT program included orthopaedic manual therapy with the aim of restoring the function of the upper thoracic aperture is to be recommended, and long-term following is advisable. 1. Mean treatment duration was over an 11.4 day(range 4~24). 2. At the follow-up evaluation, 88.1% of the patients were satisfied with the effects of their therapy. 3. 73% of the patients returened to work after PT and 88% of the patients carried through the recommendations given at discharge during follow up. 4. Normalized grip strength and Tinel' sign predicted patient satisfaction(p< .001) and return to work(p< .001). 5. Return to work was more often successful if the work was sedentary rather than heavy (p< .05).

• The Korean Journal of Pain
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• 제19권2호
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• pp.296-298
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• 2006

Droopy shoulder syndrome (DSS) is a rare disease, characterized by drooping shoulders, which stretches the brachial plexus, and causes pain, but without any signs of neurological impairment. These patients suffer from pain in the neck, shoulders, arms and hands, which result in long, graceful, swan necks, low-set shoulders, and horizontal or down sloping clavicles. No abnormalities in the vascular, neurological or electrical findings have also been known. The T1 and/or T2 bodies can be seen in the lateral view in a radiological study of the cervical spine. In the majority of cases, conservative treatments, such as postural correction and shoulder girdle strengthening exercise, are commonly recommended. However, DSS may be misdiagnosed as severe thoracic outlet syndrome or herniated cervical disc disease, leading to unnecessary and hazardous invasive treatments. The presented case was consistent with DSS, and was treated with stellate ganglion block, trigger point injection, and shoulder girdle strengthening exercise.

• The Journal of Korean Physical Therapy
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• 제17권2호
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• pp.107-125
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• 2005

The term of TOS(thoracic outlet syndrome) is used to describe patients with compressed subclavian artery, subclavian vein, and the brachial plexus in the region of the thoracic outlet. The objective of this study was to evaluate a conservative physical therapy that aims to restore normal function to the upper aperture in patients with TOS. The efficacy of this study which is conservative physical therapy, was assessed by pain, grip power, pinch grip, and satisfaction level of patients. The results were as follow; 1. Pain(VAS) was statistically significant with Group 1 and Group 2(P<0.05), and Group 2 was more statistically significant than Group 1(P<0.05). 2. Spherical grip was statistically significant with Group 1 and Group 2(P<0.05), and Group 2 was more statistically significant than Group 1(P<0.05). 3. Pinch grip was statistically significant with group 1 and Group 2(P<0.05), and Group 2 was more statistical significance than Group 1(P<0.05). 4. Satisfaction level was statistically significant with group 1 and Group 2(P<0.05), and Group 2 was more statistically significant than Group 1(P<0.05).

• 척추신경추나의학회지
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• 제13권1호
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• pp.55-68
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• 2018

Objectives: The objective of this study was to review the trends of Korean medicine-based treatment for thoracic outlet syndrome(TOS). Methods: Korean and foreign on-line databases(Pubmed, Cochran Library, CNKI, NDSL KISS and OASIS) were researched for articles discussing Korean medicine-based treatment for TOS. Repeated articles, review articles, commentaries, and those not relevant to the topic of study were excluded. Results: The total number of studies selected was 26, which included 18 case reports and 8 randomized controlled trials(RCT). In these studies, acupuncture, pharmacopuncture, acupotomy, and warm acupuncture were used as interventions for TOS.Chuna therapy was found to be the most commonly used combination treatment. Despite the high prevalence of TOS, only 3 case reports of the 26 studies selected in this review were published in Korean academic journals. Conclusions: In this study, we analyzed the trends of traditional Korean medicine-based treatment for TOS. The results showed that Korean medicine-based treatment could be an effective method for treating TOS.

• Journal of Chest Surgery
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• 제40권6호
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• pp.451-454
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• 2007

흉곽출구 증후군에서 쇄골하 정맥혈전증은 그리 흔한 질환은 아니지만 혈전 용해술 및 풍선 성형술 또는 스텐트 등의 시술이 필요하게 되고 수술을 통한 첫 번째 늑골절제술과 정맥수술을 요하는 질환이다. 저자들은 경액와 접근법이 아닌 쇄골내측절제술을 통한 구조물 감압과 내경정맥 치환술 후 스텐트 삽입을 하여 좋은 결과를 얻었기에 보고하고자 한다.

• Journal of Chest Surgery
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• 제31권9호
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• pp.903-906
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• 1998

양측의 불완전한 경추 늑골을 가진 17세 남자 인쇄공이 10일 전부터 좌측 상지를 약 45도 외향시킬 경우 즉시 심한 통증, 파행, 창백증, 상지의 무기력증이 나타나고, 90도 이상 외향시키면 증상이 악화되어 직장생활을 전혀 할 수 없이 무능력해졌다. 체위변화 쇄골하동맥 조영술상 상지의 90도 외향시 경추늑골 직하 부에서 동맥의 완전 폐쇄 소견을 나타내었다. 쇄골상 절개와 쇄골하 절개의 병용으로 앞경추늑골근절제술, 중간경추늑골근 부분절제술, 경추늑골절제술, 제1 늑골절제술, 동맥박리술을 시행하였다. 수술후 증상이 소실되어 직장에 복귀하였고 술후 10개월인 현재 까지 증상이 없이 지내고 있다.