The enigma of neurogenic thoracic outlet syndrome following motor vehicle collisions
Background The concept of neurogenic thoracic outlet syndrome (N-TOS) including upper and lower plexus syndromes secondary to soft tissue neck injury after motor vehicle collisions (MVCs) has been contentious. We considered that analysis of objective data from this group of patients could provide in...
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| Veröffentlicht in: | Canadian Journal of Surgery 2016-08, Vol.59 (4), p.276-280 |
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| creator | Munro, A. Ian, MBBS McPherson, G. Duncan, MD, PhD |
| description | Background The concept of neurogenic thoracic outlet syndrome (N-TOS) including upper and lower plexus syndromes secondary to soft tissue neck injury after motor vehicle collisions (MVCs) has been contentious. We considered that analysis of objective data from this group of patients could provide insight into this controversial type of N-TOS. Methods During the 10-year period January 2001 through December 2010 we examined patients who had received a diagnosis of N-TOS following an MVC. We graded the principal diagnosis based on the objective data from our physical examination. Results In total 263 patients received a diagnosis of N-TOS during the study period. At the highest accuracy level of diagnosis there were 56 patients with ulnar entrapment syndrome (UES), 40 with carpal tunnel syndrome (CTS) and 55 with nonorganic disease (NOD), for a total of 151 (57.4%) cases in which the diagnosis of N-TOS was brought into question. The elevated arm stress test (EAST) reproduced the symptoms of UES in 33 of the 56 patients of UES (58.9%) and reproduced the symptoms of CTS in 18 of the 40 patients with CTS (45.0%). Conclusion There appears to be a high incidence of misdiagnosis of N-TOS following MVCs. The EAST is not a prime test for N-TOS. |
| doi_str_mv | 10.1503/cjs.009814 |
| format | Article |
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Ian, MBBS ; McPherson, G. Duncan, MD, PhD</creator><creatorcontrib>Munro, A. Ian, MBBS ; McPherson, G. Duncan, MD, PhD</creatorcontrib><description>Background The concept of neurogenic thoracic outlet syndrome (N-TOS) including upper and lower plexus syndromes secondary to soft tissue neck injury after motor vehicle collisions (MVCs) has been contentious. We considered that analysis of objective data from this group of patients could provide insight into this controversial type of N-TOS. Methods During the 10-year period January 2001 through December 2010 we examined patients who had received a diagnosis of N-TOS following an MVC. We graded the principal diagnosis based on the objective data from our physical examination. Results In total 263 patients received a diagnosis of N-TOS during the study period. At the highest accuracy level of diagnosis there were 56 patients with ulnar entrapment syndrome (UES), 40 with carpal tunnel syndrome (CTS) and 55 with nonorganic disease (NOD), for a total of 151 (57.4%) cases in which the diagnosis of N-TOS was brought into question. The elevated arm stress test (EAST) reproduced the symptoms of UES in 33 of the 56 patients of UES (58.9%) and reproduced the symptoms of CTS in 18 of the 40 patients with CTS (45.0%). Conclusion There appears to be a high incidence of misdiagnosis of N-TOS following MVCs. The EAST is not a prime test for N-TOS.</description><identifier>ISSN: 0008-428X</identifier><identifier>EISSN: 1488-2310</identifier><identifier>DOI: 10.1503/cjs.009814</identifier><identifier>PMID: 27454840</identifier><identifier>CODEN: CJSUAX</identifier><language>eng</language><publisher>Canada: Joule Inc</publisher><subject>Accidents, Traffic ; Adult ; Carpal tunnel syndrome ; Diagnosis ; Diagnostic Errors - statistics & numerical data ; Diseases ; Electromyography ; Female ; Humans ; Influence ; Male ; Medical examination ; Risk factors ; Studies ; Surgery ; Thoracic outlet syndrome ; Thoracic Outlet Syndrome - diagnosis ; Thoracic Outlet Syndrome - epidemiology ; Thoracic Outlet Syndrome - etiology ; Traffic accidents ; Traffic accidents & safety</subject><ispartof>Canadian Journal of Surgery, 2016-08, Vol.59 (4), p.276-280</ispartof><rights>Joule Inc. or its licensors</rights><rights>COPYRIGHT 2016 Joule Inc.</rights><rights>Copyright 8872147 Canada Inc. Aug 2016</rights><rights>2016 Joule Inc. or its licensors 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c622t-2de3cbad196b117cb43b1014773d639ec842705f4d651d09273fd530ba7ad5323</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961491/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961491/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,725,778,782,883,27911,27912,53778,53780</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27454840$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Munro, A. Ian, MBBS</creatorcontrib><creatorcontrib>McPherson, G. Duncan, MD, PhD</creatorcontrib><title>The enigma of neurogenic thoracic outlet syndrome following motor vehicle collisions</title><title>Canadian Journal of Surgery</title><addtitle>Can J Surg</addtitle><description>Background The concept of neurogenic thoracic outlet syndrome (N-TOS) including upper and lower plexus syndromes secondary to soft tissue neck injury after motor vehicle collisions (MVCs) has been contentious. We considered that analysis of objective data from this group of patients could provide insight into this controversial type of N-TOS. Methods During the 10-year period January 2001 through December 2010 we examined patients who had received a diagnosis of N-TOS following an MVC. We graded the principal diagnosis based on the objective data from our physical examination. Results In total 263 patients received a diagnosis of N-TOS during the study period. At the highest accuracy level of diagnosis there were 56 patients with ulnar entrapment syndrome (UES), 40 with carpal tunnel syndrome (CTS) and 55 with nonorganic disease (NOD), for a total of 151 (57.4%) cases in which the diagnosis of N-TOS was brought into question. The elevated arm stress test (EAST) reproduced the symptoms of UES in 33 of the 56 patients of UES (58.9%) and reproduced the symptoms of CTS in 18 of the 40 patients with CTS (45.0%). Conclusion There appears to be a high incidence of misdiagnosis of N-TOS following MVCs. The EAST is not a prime test for N-TOS.</description><subject>Accidents, Traffic</subject><subject>Adult</subject><subject>Carpal tunnel syndrome</subject><subject>Diagnosis</subject><subject>Diagnostic Errors - statistics & numerical data</subject><subject>Diseases</subject><subject>Electromyography</subject><subject>Female</subject><subject>Humans</subject><subject>Influence</subject><subject>Male</subject><subject>Medical examination</subject><subject>Risk factors</subject><subject>Studies</subject><subject>Surgery</subject><subject>Thoracic outlet syndrome</subject><subject>Thoracic Outlet Syndrome - diagnosis</subject><subject>Thoracic Outlet Syndrome - epidemiology</subject><subject>Thoracic Outlet Syndrome - etiology</subject><subject>Traffic accidents</subject><subject>Traffic accidents & safety</subject><issn>0008-428X</issn><issn>1488-2310</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNptkluL1DAYhoso7rh64w-QoiAqdMyppxthWTwsLHqxI-xdSNOvbca0mU3S0fn3psy6M5UhF18OT94c3jeKXmK0xCmiH-XaLREqC8weRQvMiiIhFKPH0QIhVCSMFLdn0TPn1ghhRFn5NDojOUtZwdAiWq06iGFQbS9i08QDjNa0YSxj3xkrZOiY0WvwsdsNtTU9xI3R2vxWQxv3xhsbb6FTUkMsw7xyygzuefSkEdrBi_t6Hv388nl1-S25_vH16vLiOpEZIT4hNVBZiRqXWYVxLitGK4wwy3NaZ7QEWTCSo7RhdZbiGpUkp02dUlSJXIRK6Hn0aa-7GaseagmDt0LzjVW9sDtuhOLzlUF1vDVbzsoMsxIHgXf3AtbcjeA875WToLUYwIyO4wLlJE_ztAjom__QtRntEJ43UWVJS0bwgWqFBq6GxoRz5STKL1iGaIEpQYFKTlDh2yFc0gzQqDA941-f4OVG3fFjaHkCCq2GXsmTqu9nGwLj4Y9vxegcv7r5PmffHrEdCO07Z_ToJ7vn4Ic9KK1xzkLz4AZGfEorD2nl-7QG-NWxfw_ov3geDIaQoq0Cy6VWIZxC_4IduIMD3BGO-M0U-CnvOKOIUHZL_wIZ1PX7</recordid><startdate>20160801</startdate><enddate>20160801</enddate><creator>Munro, A. 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Duncan, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c622t-2de3cbad196b117cb43b1014773d639ec842705f4d651d09273fd530ba7ad5323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Accidents, Traffic</topic><topic>Adult</topic><topic>Carpal tunnel syndrome</topic><topic>Diagnosis</topic><topic>Diagnostic Errors - statistics & numerical data</topic><topic>Diseases</topic><topic>Electromyography</topic><topic>Female</topic><topic>Humans</topic><topic>Influence</topic><topic>Male</topic><topic>Medical examination</topic><topic>Risk factors</topic><topic>Studies</topic><topic>Surgery</topic><topic>Thoracic outlet syndrome</topic><topic>Thoracic Outlet Syndrome - diagnosis</topic><topic>Thoracic Outlet Syndrome - epidemiology</topic><topic>Thoracic Outlet Syndrome - etiology</topic><topic>Traffic accidents</topic><topic>Traffic accidents & safety</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Munro, A. Ian, MBBS</creatorcontrib><creatorcontrib>McPherson, G. 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Ian, MBBS</au><au>McPherson, G. Duncan, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The enigma of neurogenic thoracic outlet syndrome following motor vehicle collisions</atitle><jtitle>Canadian Journal of Surgery</jtitle><addtitle>Can J Surg</addtitle><date>2016-08-01</date><risdate>2016</risdate><volume>59</volume><issue>4</issue><spage>276</spage><epage>280</epage><pages>276-280</pages><issn>0008-428X</issn><eissn>1488-2310</eissn><coden>CJSUAX</coden><abstract>Background The concept of neurogenic thoracic outlet syndrome (N-TOS) including upper and lower plexus syndromes secondary to soft tissue neck injury after motor vehicle collisions (MVCs) has been contentious. We considered that analysis of objective data from this group of patients could provide insight into this controversial type of N-TOS. Methods During the 10-year period January 2001 through December 2010 we examined patients who had received a diagnosis of N-TOS following an MVC. We graded the principal diagnosis based on the objective data from our physical examination. Results In total 263 patients received a diagnosis of N-TOS during the study period. At the highest accuracy level of diagnosis there were 56 patients with ulnar entrapment syndrome (UES), 40 with carpal tunnel syndrome (CTS) and 55 with nonorganic disease (NOD), for a total of 151 (57.4%) cases in which the diagnosis of N-TOS was brought into question. The elevated arm stress test (EAST) reproduced the symptoms of UES in 33 of the 56 patients of UES (58.9%) and reproduced the symptoms of CTS in 18 of the 40 patients with CTS (45.0%). Conclusion There appears to be a high incidence of misdiagnosis of N-TOS following MVCs. The EAST is not a prime test for N-TOS.</abstract><cop>Canada</cop><pub>Joule Inc</pub><pmid>27454840</pmid><doi>10.1503/cjs.009814</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Accidents, Traffic Adult Carpal tunnel syndrome Diagnosis Diagnostic Errors - statistics & numerical data Diseases Electromyography Female Humans Influence Male Medical examination Risk factors Studies Surgery Thoracic outlet syndrome Thoracic Outlet Syndrome - diagnosis Thoracic Outlet Syndrome - epidemiology Thoracic Outlet Syndrome - etiology Traffic accidents Traffic accidents & safety |
| title | The enigma of neurogenic thoracic outlet syndrome following motor vehicle collisions |
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