61. THORACIC OUTLET SYNDROME & The Medical Vest thoracic outlet syndrome The MediVest Syndrome. Top of page. Thoracic OutletSyndrome, TOS, is the carpal tunnel syndrome of the shoulder. The http://www.medivest.com/tos.htm

THORACIC OUTLET SYNDROME The MediVest Patented Medical Vest helps prevent against a proven professional hazard that strikes many medical professionals. Our patented medical vest helps prevent against T horacic O utlet S yndrome(TOS). TOS is an ailment that strikes many medical professionals because of the unevenly centered weight from the straps of "Black Bags" used by most Medical Professionals. On this page you can find the most common symptoms of TOS and information of how our patented Medical Vest helps to prevent this hazard striking America's medical professionals at an alarming rate. What is TOS? What can be done about TOS? What are some symptoms of TOS? TOS Also Known As: Thoracic Outlet Compression Syndrome Top of page T horacic Outlet Syndrome, TOS, is the "carpal tunnel syndrome" of the shoulder. The most common victims of TOS are Home care nurses, emergency medical professionals, postal workers and soldiers. All of these professions involve carrying of heavy bags or backpacks that cause downward pressure of the clavicle against the first rib. This causes a tendency to shear the neurovascular bundle. Heavy direct load bearing and work which requires pulling the shoulders back and down such as carrying a shoulder bag or a backpack are some of the most direct causes of TOS. T his is a simplified drawing of the anatomy of the thoracic outlet. The drawing is that of the front, right side of a human. This is most often the dominant side and most commonly the shoulder that is used to carry heavy medical equipment and where the straps of an emergency medical professional's knapsack would be placed. This is considered a "cumulative trauma". The clavicle lies across the first Between the two (clavicle and first rib) are 3 tubes which carry blood and nerves. This area where 3 tubes come out is called the "Thoracic Outlet". When a heavy object, such as a backpack or shoulder bag is carried on the shoulder, the clavicle is pushed down against the first rib and compresses the nerves, artery and vein causing TOS.

62. 404 Error - Page Not Found thoracic outlet syndrome. The thoracic outlet syndrome is a compressionneuropathy affecting the lower roots of the brachial plexus http://www.hse.gov.uk/hthdir/noframes/musculo/helli_08.htm

HSE Homepage A-Z index Feedback Search ... Sitemap Error 404 - Page not found Sorry, your web browser cannot find the page that you are looking for. This may be due to one of the following reasons: The web address has been typed incorrectly The web page may have moved to a different place on the server The web page no longer exists Please try one of the following options: Check the web page address and re-enter If the web page has moved or has been deleted, try searching the website using the search feature below Search search help We have recently moved files in the following areas of the website Railways website CHIP website SPD website Asbestos website and managing asbestos campaign website Consultation and Discussion documents

63. Thoracic Outlet Syndrome thoracic outlet syndrome. What is thoracic outlet syndrome? Within the NINDS researchprograms, thoracic outlet syndrome is addressed through research on pain. http://www.clevelandclinic.org/health/health-info/docs/1300/1355.asp?index=6123

64. Vascular Surgery Thoracic Outlet Syndrome thoracic outlet syndrome is a condition where nerves and/or vascular structures arecompressed in the shoulder region by the first rib, accessory (cervical rib http://www.clevelandclinic.org/vascular/surgery/thoracic.htm

Non-Invasive Vascular Laboratory Overview Physician Directory Related Sites ... The Cleveland Clinic January 6, 2000

65. NINDS Thoracic Outlet Syndrome Information Page thoracic outlet syndrome information sheet compiled by the National Institute ofNeurological Disorders and Stroke (NINDS). What is thoracic outlet syndrome? http://accessible.ninds.nih.gov/health_and_medical/disorders/thoracic_doc.htm

Disorders - National Institute of Neurological Disorders and Stroke (NINDS) Skip menus Main sections of the NINDS web site Home About NINDS Disorders-you are in this section ... Find People Disorders section pages and search Image Description Science For the Brain The nation's leading supporter of biomedical research on disorders of the brain and nervous system. Select Topic Disorder Quick Links Alzheimer's Autism Cerebral Palsy Chronic Pain Epilepsy Headache Multiple Sclerosis Parkinson's Stroke Traumatic Brain Injury More about NINDS Thoracic Outlet Syndrome Information Page Studies with patients Research literature Press release NINDS Search (search help) Contact us My privacy NINDS is part of the National Institutes of Health Contact us Content for this page NINDS Thoracic Outlet Syndrome Information Page Reviewed 10-11-2002 Get Web page suited for printing Email this to a friend or colleague Table of Contents (click to jump to sections) What is Thoracic Outlet Syndrome? Is there any treatment? What is the prognosis? What research is being done? ... Additional resources from MEDLINEplus What is Thoracic Outlet Syndrome? Thoracic outlet syndrome (TOS) consists of a group of distinct disorders that affect the nerves in the brachial plexus (nerves that pass into the arms from the neck) and various nerves and blood vessels between the base of the neck and axilla (armpit). For the most part, these disorders have very little in common except the site of occurrence. The disorders are complex, somewhat confusing, and poorly defined, each with various signs and symptoms of the upper limb.

66. Thoracic Outlet Syndrome First Previous Next Last Index Home Text. Slide 29 of 49. http://www.usenix.org/publications/library/proceedings/lisa98/invited_talks/okam

67. Thoracic Outlet Syndrome First Previous Next Last Index Text, Slide 28 of 45. http://www.usenix.org/publications/library/proceedings/usenix98/invited_talks/ok

68. Thoracic And Outlet And Syndrome thoracic and outlet and syndrome A web page explaining the diagnosis of ThoracicOutlet Syndrome including, but not thoracic outlet syndrome. http://www.conacamiperu.org/

69. Thoracic Outlet Syndrome thoracic outlet syndrome. Jonathan B. Towne, MD, John Corson, MD, Irving Kron,MD. To be aware of the incidence of recurrence of thoracic outlet syndrome. http://www.vascularweb.org/doc/454

Thoracic Outlet Syndrome Jonathan B. Towne, M.D., John Corson, M.D., Irving Kron, M.D. I. Anatomy and Pathophysiology To understand the anatomy of the thoracic outlet to include anatomic variations in bones, muscles, and cervical ribs. To recognize the origin of insertion of the musculoskeletal structures which surround the nerves and blood vessels that supply the arm. To recognize the location of the costovertebral ligaments and the boundaries of the scalene triangle and the costoclavicular space. To recognize the location and incidence of anatomic variations of the insertion of the cervical rib. To recognize insertions of the anterior scalene and its relationship to the neurovascular structures. To recognize the origin and insertion of the subclavius muscle and the possibility of encroaching the neurovascular structures in the costoclavicular triangle. To recognize and define skeletal abnormalities, e.g. elongated C-7 transverse process, callous formation from a fractured clavicle or first rib, hypoplastic first rib, the anatomy of cervical nerves C-5, C-6, C-7, C-8, and T-1, and their relationships to the thoracic outlet. II. Diagnostic Evaluation

70. CTSN - Thoracic Outlet Syndrome thoracic outlet syndrome. Click on hyperlinked text for illustrations. http://www.ctsnet.org/residents/ctsn/archives/21txt.html

Thoracic Outlet Syndrome Click on hyperlinked text for illustrations 1. Definition Compression of the subclavian vessels and brachial plexus at the superior aperture of the chest, most commonly against the first rib. Other terms for this syndrome include scalenus anticus syndrome, costoclavicular syndrome, hyperabduction syndrome, cervical rib syndrome, and first thoracic rib syndrome. 2. Anatomy A. Surgical Anatomy first rib divides the cervicoaxillary canal into a proximal space and a distal space (the axilla) B. Functional Anatomy 3. Etiology There are many factors which can cause neurovascular compression at the thoracic outlet. Bony abnormalities are present in about 30% of patients, and some of these may be visualized on plain chest x-ray. I. Anatomic Factors II. Congenital Factors III. Traumatic Factors IV. Atherosclerosis *adapted from Kirklin and Barratt-Boyes 4. Clinical Presentation The character and pattern of symptoms will vary depending on the degree to which nerves, blood vessels, or both are compressed A. Neurogenic

71. CTSN - Thoracic Outlet Syndrome thoracic outlet syndrome References Selected Articles Urschel HC Jrand Razzuk MA. thoracic outlet syndrome A current overview. http://www.ctsnet.org/residents/ctsn/archives/21refer.html

Thoracic Outlet Syndrome References Selected Articles Urschel HC Jr and Razzuk MA. The failed operation for thoracic outlet syndrome: The difficulty of diagnosis and management . Annals of Thoracic Surgery 1997 63(4):935-9. This series of over 2200 patients treated with the transaxillary approach has impressive results - over 90% of patients had excellent or good relief of symptoms. Importantly, there was no significant difference in the results and relief of symptoms from upper or lower plexus compression. MacKinnon SE, Patterson GA, Novak CB. Thoracic outlet syndrome: A current overview . Seminars in Thoracic and Cardiovascular Surgery 1996 8(2):176-82. This is the lead article in the second section of this issue dedicated to thoracic outlet syndrome and focuses on the careful clinical evaluation as the key to properly treating this difficult patient population. Urschel HC Jr. Dorsal sympathectomy and management of thoracic outlet syndrome with VATS . Annals of Thoracic Surgery 1993 56(3):717-20. The author discusses two techniques for using VATS: standard three-port and transaxillary first rib removal. Excellent relief has been obtained with the sympathectomy.

72. CTD: Thoracic Outlet Syndrome thoracic outlet syndrome. Back to Home. Feedback? mmg@sechrest.com. Anatomy. ThoracicOutlet Syndrome (TOS) is a condition affecting the shoulder, arm, and hand. http://www.healthpages.org/AHP/LIBRARY/HLTHTOP/CTD/tos.htm

Thoracic Outlet Syndrome Feedback? mmg@sechrest.com Anatomy Thoracic Outlet Syndrome (TOS) is a condition affecting the shoulder, arm, and hand. Nerves and blood vessels supplying the arm and hand start at the side of the neck. Exiting from the side of the spine, they travel between two muscles (the scalenes), over the top of the rib cage (thorax), under the collar bone (clavicle), through the arm pit (axilla) and down the arm to the hand. The area where the nerves and vessels leave the neck between the two scalene muscles and over the first rib is know as the Thoracic Outlet Causes There are probably several causes of TOS. The common underlying cause of the syndrome is compression of the nerves and arteries of the arm in the Thoracic Outlet . Some people have an extra first rib or an old fracture of the clavicle, which limits the space for the vessels. A violent injury , such as a car wreck while wearing a shoulder harness, may also tear the scalene muscles. In the healing phases of this type injury, scar tissue may form in the healing muscle, leading to compression of the nerves and vessels. Compression can also occur with repetitive activities that require the arms to be held overhead or extended forward. The more likely cause is slouching forward and

73. CyberSpace Search! SEARCH THE WEB. Results 1 through 8 of 8 for thoracic outlet syndrome. http://www.cyberspace.com/cgi-bin/cs_search.cgi?Terms=thoracic outlet syndrome

74. Thoracic Outlet Syndrome Clinic Thoracic Outlet Clinic This page best viewedat 800 X 600 pixels on your computer! http://www.tos-clinic.com/Frames Top.htm

Thoracic Outlet Clinic This page best viewed at 800 X 600 pixels on your computer!

75. CCHS Clinical Digital Library thoracic outlet syndrome Clinical Resources. Wheeless' Textbook of OrthopaedicsTable of contents thoracic outlet syndrome Access document. http://cchs-dl.slis.ua.edu/clinical/cardiology/cardiovascular/pvd/arterial/thora

Clinical Resources by Topic: Cardiovascular Disorders Thoracic Outlet Syndrome Clinical Resources Emergency Radiology Clinical Guidelines News ... Miscellaneous Resources See also: Cardiovascular Clinical Procedure Resources General Cardiovascular Disorders Clinical Resources Thoracic Outlet Syndrome Patient/Family Resources Harrison's Principles of Internal Medicine 15th Ed.-2001: Table of contents Health Sciences Library subscription INFO Chapter 248: Vascular Diseases of the Extremities Table of contents Arterial Disorders: Access document Thoracic Outlet Compression Syndrome: Access document Treatment: Access document DeLee: DeLee and Drez's Orthopaedic Sports Medicine 2nd Ed.-2003 (MD Consult): Table of contents Health Sciences Library subscription INFO Chapter 21 - Shoulder: Access document Section O Thoracic Outlet Syndrome: Access document History: Access document Anatomy: Access document Symptoms: Access document Physical Examination: Access document Provocative Signs: Access document Diagnostic Studies: Access document Nonsurgical Treatment: Access document Surgical Treatment: Access document Criteria for Return to Sports Participation: Access document Authors' Preferred Method of Treatment: Access document References: Access document Goetz: Textbook of Clinical Neurology 1st Ed.-1999 (MD Consult):

76. Thoracic Outlet Syndrome thoracic outlet syndrome (TOS). Click HERE for Anatomy of ThoracicOutlet Syndrome. Clinical Presentation of TOS. Neural Compression. http://doctorwhiplash.com/New Stuff/Thoracic Outlet Syndrome.htm

Thoracic Outlet Syndrome (TOS) Thoracic outlet or inlet syndrome is a complex of signs and symptoms that result from compression of the neurovascular bundle as it emerges from the thorax and enters the upper limb. Depending on the site of compression and the structure involved, there are a variety of clinical manifestations. The presenta­tion may be confusing, and the complaints and physi­cal findings are often vague. Indeed there is debate as to the existence of such a syndrome; and as a result, the attitude of the clinician dictates whether this syn­drome is diagnosed with regularity or not at all. There are two major components to the syndrome, the first relating to problems with the major vessels and the second to pressure on the nerves. If there is thrombosis of the subclavian artery or vein, it is a clearly defined entity that is easily confirmed and usually presents with dramatic clinical signs. There is no speculation regarding this problem. By contrast, the neural signs and symptoms are more difficult to pin down, even with sophisticated electrophysiologic tests. Clinical Presentation of TOS Thoracic Outlet Tests Differential Diagnosis Review of TOS ... Frequently Asked Questions (FAQ) Relevant Anatomy The narrow confines of the thoracic outlet may be considered the space between the relatively fixed im­mobile thorax, particularly the first rib, and the clavi­cle. Traditionally, this space is extended to include the triangle between the scalenus muscles, which border the roots and trunks of the brachial plexus, en route to the upper limb, within the axillary sheath. During normal development of the human shoulder girdle, the scapula descends from a relatively high position at birth to a low one during adolescence and maturation. These relations are affected by hypertrophy or atrophy of muscles and chronic postural positions. Thus as the configuration of this area changes throughout life, the possibility of a dynamic pathogenesis is possible.

77. FAQ - Thoracic Outlet Syndrome thoracic outlet syndrome. Frequently Asked Questions. 1. What isthoracic outlet syndrome? thoracic outlet syndrome (TOS http://doctorwhiplash.com/New Stuff/FAQ - Thoracic Outlet Syndrome.htm

Thoracic Outlet Syndrome Frequently Asked Questions What is thoracic outlet syndrome? Thoracic outlet syndrome (TOS) is a condition that is caused by compression of the nerves and/or blood vessels in the area of the neck, shoulder and middle back. TOS was first described in 1821 by Sir Astley Cooper. Since then, research has further defined the parts of the body involved, the clinical signs, symptoms, risk factors and eventual outcomes, diagnostic procedures, and treatment. TOS has been poorly understood for decades, and is often misdiagnosed and therefore mistreated. Recently, it has become more accepted that this condition may not be 100% verifiable using conventional diagnostic procedures and tests. What names are synonymous with TOS? There have been many names associated with TOS. They are typically used to reflect the cause or location of the symptoms. These names include fractured clavicle syndrome, pneumatic hammer syndrome, nocturnal paresthetic brachialgia, rucksack paralysis, cervicobrachial neurovascular com­pression syndrome. and shoulder-hand syndrome. While descriptive, most health care providers use the terms scalenus anticus syndrome costoclavicular syndrome , and pectoralis minor syndrome to describe the three primary anatomic areas most affected in thoracic outlet syndrome.

78. Thoracic Outlet Syndrome MAIN SEARCH INDEX thoracic outlet syndrome. The pain of thoracic outlet syndromeis sometimes confused with the pain of angina that indicates heart problems. http://www.hendrickhealth.org/healthy/001346.htm

MAIN SEARCH INDEX Thoracic outlet syndrome Definition Description Causes and symptoms Diagnosis ... Resources Definition Thoracic outlet syndromes are a group of disorders that cause pain and abnormal nerve sensations in the neck, shoulder, arm, and/or hand. Description The thoracic outlet is an area at the top of the rib cage, between the neck and the chest. Several anatomical structures pass through this area, including the esophagus, trachea, and nerves and blood vessels that lead to the arm and neck region. The area contains the first rib; collar bone (clavicle); the arteries beneath the collar bone (subclavian artery), which supply blood to the arms; a network of nerves leading to the arms (brachial plexus); and the top of the lungs. Pain and other symptoms occur when the nerves or blood vessels in this area are compressed. The likelihood of blood vessels or nerves in the thoracic outlet being compressed increases with increased size of body tissues in this area or with decreased size of the thoracic outlet. The pain of thoracic outlet syndrome is sometimes confused with the pain of angina that indicates heart problems. The two conditions can be distinguished from each other because the pain of thoracic outlet syndrome does not appear or increase when walking, while the pain of angina does. Also, the pain of thoracic outlet syndrome usually increases if the affected arm is raised, which does not happen in cases of angina.

79. Trans-axillary First Rib Excision For Thoracic Outlet Syndrome Transaxillary first rib excision for thoracic outlet syndrome. Keywords thoracicoutlet syndrome, diagnosis, prevalence, trans-axillary excision. http://www.rcsed.ac.uk/journal/vol44_6/4460004.htm

ORIGINAL ARTICLES Trans-axillary first rib excision for thoracic outlet syndrome DAVID P. EDWARDS*, EDWARD MULKERN#, AHMED N. RAJA* and PHILIP BARKER* *Department of Surgery, Royal Hospital Haslar, Gosport, Hants UK and #Department of Surgery, Peterborough Hospital, Peterborough, U.K. Keywords: thoracic outlet syndrome, diagnosis, prevalence, trans-axillary excision J.R.Coll.Surg.Edinb., 44, December 1999, 362-5 INTRODUCTION Thoracic outlet syndrome (TOS) results from compression of the brachial plexus (usually the lower roots) and/or the subclavian vessels. The true prevalence of TOS is unknown, but has been suggested as 5 per 100 000 per year. Neurological symptoms predominate, accounting for up to 90% of cases in selected series. The diagnosis of TOS is essentially clinical, and follows the exclusion of cervical and distal neuropathies. TOS presenting with vascular symptoms may be supported by arteriography, venography or vascular ultrasound, but normal findings on these investigations do not exclude TOS. Diagnostic difficulties in this uncommon syndrome may result in its under-diagnosis. Surgical decompression of the thoracic outlet is achieved by resection of the first rib, performed via the cervical

80. Surgical Decompression Of Thoracic Outlet Compression Syndrome ORIGINAL ARTICLES. Longterm results of surgical decompression of thoracic outletcompression syndrome. Surgical decompression for thoracic outlet syndrome. http://www.rcsed.ac.uk/journal/vol46_1/4610006.htm

ORIGINAL ARTICLES Long-term results of surgical decompression of thoracic outlet compression syndrome C.A. MAXWELL-ARMSTRONG,* B.S.W. NOORPURI,* S. ABDUL HAQUE,* D.M. BAKER# and A.J. LAMERTON* *Department of Surgery, Lincoln County Hospital, Greetwells Rd, Lincoln, U.K. and #Department of Vascular Surgery, Royal Free Hospital, Pond Street, London, U.K. Introduction Patients and methods Results Discussion ... References Keywords: Cervical rib, thoracic outlet compression syndrome J.R.Coll.Surg.Edinb., 46, February 2001, 35-38 INTRODUCTION Thoracic outlet compression syndrome (TOCS) is characterised by symptoms relating to compression of the neurovascular bundle by anatomical abnormalities such as cervical rib, fibrous bands, and variations in scalene musculature. Symptoms may be neurological and vasomotor, with diagnosis made after exclusion of conditions that present with similar clinical features. No one test is specific for TOCS. The treatment is surgical decompression, with relief of symptoms in between 52% and 99% of patients. A number of operations have been described to treat TOCS, including division of scalenus anterior alone (scalenectomy),9 first rib resection by transaxillary, transthoracic or posterior approaches

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