DOCSLIB.ORG

An Osteopathic Approach to Conservative Management of Thoracic Outlet Syndromes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
An Osteopathic Approach to Conservative Management of Thoracic Outlet Syndromes An osteopathic approach to conservative management of thoracic outlet syndromes RICHARD DOBRUSIN, DO Thoracic outlet syndromes lateral border of the first rib. It then passes under (TOS) are a group of disorders in which the clavicle and subclavius muscle. It enters the there is compression of the brachial plexus axilla by passing between the tendon of the pector- or the subclavian artery or vein or both as alis minor muscle (as it inserts onto the coracoid they pass through the thoracic outlet. Most process of the scapula) and the head of the patients have neurologic symptoms of the humerus. The subclavian vein follows a similar arm and hand. These syndromes are course, the principal exception being that it passes generally named according to the site of anterior to the scalenus anticus muscle as it en- compression or the compressing structures. ters the outlet. There are many factors that predispose The brachial plexus is normally made up of con- patients to the development of TOS. The tributing nerve fibers from cervical nerve roots differential diagnosis includes many 5,6,7, and 8 and thoracic nerve root 1. Cervical diseases that can add to or imitate TOS nerve roots 5 and 6 join at the lateral border of symptoms. Diagnosis is based mainly on the the scalenus medius to form the upper trunk of the findings of the history and physical plexus. The middle trunk is made up of fibers from examination. Most patients respond well to cervical nerve root 7. Cervical nerve root 8 and tho- a conservative care regimen, which should racic nerve root 1 form the lower trunk of the be tailored to the individual patients needs. plexus. These trunks pass behind the clavicle where In most instances, surgery should be each splits into an anterior and posterior division. reserved as a treatment of last resort. The anterior divisions of the upper and middle trunks form the lateral cord of the plexus. The an- The thoracic outlet syndromes (TOS) are a group terior division of the lower trunk forms the medial of disorders in which the patients symptoms are cord of the plexus. The posterior divisions of all caused by compression of the brachial plexus or three trunks join to form the posterior cord. These the subclavian artery or vein or both. These syn- cords are named according to their relationship to dromes can be classified as entrapment neuropa- the axillary artery. The cords then go on to form thies and are named according to the site of com- the peripheral nerves of the arm. The sympathetic pression. The true frequency of these disorders is supply to the upper extremities arises from the up- unknown owing to the difficulty in establishing per thoracic area. It travels through the thoracic strict diagnostic criteria. The diagnosis of these syn- outlet and makes up 8% of the brachial plexus. dromes is based largely on the findings of a thor- ough patient history and a physical examination. 1rpes of thoracic outlet syndromes The scalenus anticus syndrome and the cervical rib Anatomic relationships syndrome are similar in that both cause compres- The thoracic outlet is an anatomic space bordered sion in the interscalene triangle. They develop by the first thoracic rib, the clavicle, and the supe- when there is compression of the brachial plexus rior border of the scapula. The neurovascular sup- or subclavian artery or both as they pass between ply to the arm must pass through this space. There the scalenus anticus and the scalenus medius mus- are many congenital variations, but the descrip- cles and over the first thoracic rib. The costoclavi- tion given here is the most common anatomic cular syndrome is caused by compression ()file bra- arrangement. chial plexus or the axillary artery and vein or both The subclavian artery leaves the thoracic cavity as they pass between the first thoracic rib snd the and passes above the first rib and between the scale- clavicle. The pectoralis minor syndrome is also nus anticus and scalenus medius muscles. The sub- called the coracoid-pectoralis syndrome or the clavian artery becomes the axillary artery at the hyperabduction syndrome. It is caused bycompres- 1046 • JAOA • Vol 89 • No 8 • August 1989 Clinical Practice • Dobrusin sion of the axillary artery and, the brachial plexus Table 1 between the pectoralis minor tendon (as it inserts Factors That Predispose to Thoracic Outlet Syndromes onto the coracoid process of the scapula) and the humeral head. • Cervical ribs and long transverse processes of C-7 • Abnormal fibrous bands and/or scalenus medius insertions Predisposing factors • Abnormal first thoracic ribs There are many factors that predispose patients • Postural changes Localized and distant areas of somatic dysfunction to TOS (Table 1). The presence of these factors does • • Trauma not necessarily mean that these patients will be • Degenerative changes unresponsive to conservative management. Also, there often is no cause-and-effect relationship be- tween these factors and the syndromes. However, an understanding of these factors will enable the to the neuromuscular strains placed on the body. physician to take a more comprehensive approach Patients with poor posture in general are prone to the problem. to neuromusculoskeletal stresses. They will often Cervical ribs are present in approximately 1% have altered body mechanics due to excessive tho- of the population. 2 When present, they are bilat- racic kyphotic curves with associated increased cer- eral 75% of the time. These ribs may be associated vical lordosis. This condition leads to strain of the with soft-tissue fibrous bands that usually insert supporting musculature and compression of the tho- onto the first thoracic rib. Some patients also have racic outlet space. In essence, these patients have long transverse processes of the seventh cervical to work too hard to maintain an erect posture. vertebra. These processes can be either unilateral Areas of somatic dysfunction causing compres- or bilateral. Both types of findings are easily demon- sion either through direct or reflex mechanisms are strated on standard cervical spine x-ray films. The usually found in patients with TOS. It is impor- presence of cervical ribs or long transverse proc- tant to be aware that somatic dysfunction of the esses does not preclude the successful use of con- cervical spine can play a key role in TOS. The scale- servative care measures. nus anticus is innervated by branches of cervical Abnormal fibrous bands or muscular insertions nerve roots 4, 5, and 6, while the scalenus medius can be found in the interscalene triangle. Thomas is innervated by cervical nerve roots 3, 4, 5, 6, 7, and associates3 found that 58% of those patients and 8. 1 Areas of somatic dysfunction in these ver- undergoing surgery for TOS had abnormal scale- tebrae can cause facilitation of the nerve roots and nus medius insertions. Twenty-one percent of these excessive tightness in the scalene muscles. This can patients had solitary outlet fibrous bands. These put pressure on the involved neurovascular bun- muscular insertions and fibrous bands cannot be dle directly as well as by pulling up the first rib. seen on standard x-ray films. Palpatory examination of the first rib would re- Abnormal first thoracic ribs may further close veal it to be raised and caught in inspiration. The the interscalene triangle. The first rib can develop first rib would not lower as expected with expira- a bony exostosis that may compress the structures tion. involved by narrowing the costoclavicular space. It is also important to keep in mind that distant Postural changes can greatly affect the course areas of somatic dysfunction, whether symptomatic of TOS. Certain occupations that require prolonged or not, can affect the thoracic outlet. The upper work Ma hyperabducted position (such as the work thoracic vertebrae are often involved. Areas of so- of painters and mechanics) can aggravate the con- matic dysfunction in the upper thoracic vertebrae dition. This condition is often difficult to treat be- can cause facilitation of the sympathetic outflow cause of the problems associated with correcting to the thoracic outlet and to the entire upper ex- the exacerbating posture. Often patients will as- tremity. This increased sympathetic tone is associ- sume a compressive posture while sleeping. This ated with increased muscular tone, vasoconstric- should especially be suspected in patients whose tion, decreased skin resistance, and decreased skin symptoms are worse in the mornings or who are temperature.4 In general, the area becomes more awakened by discomfort. Weight lifters are predis- prone to injury and more likely to be aggravated posed to pectoralis minor syndrome due to the char- by any other predisposing factors that may exist. acteristio-hypertrophic muscular changes and the Even more distant areas of dysfunction can af- use of the hyperabducted position during workouts. fect the thoracic outlet. Essentially, any area of Kyphoscaliosis patients are prone to TOS owing dysfunction can, through mechanical or direct Clinical Practice • Dobrusin JAOA • Vol 89 • No 8 • August 1989 • 1047 mechanisms, affect the area. For example, condi- tasks. They may also experience peripheral Hair tions that cause unleveling of the sacral base can loss. Very rarely, patients complain of symptoms cause a compensatory lumbar scoliosis. This con- of severe arterial disease such as ulcerations, gan- dition, in turn, can cause a compensatory thoracic grene, and cyanosis. Also very rarely, these pa- scoliosis, which can add to the disease process. As tients may be subject to digital infarctions result- another example, any lower-extremity injury caus- ing from embolization from a proximal aneurysm. ing altered gait and posture can have distant ef- Patients with severe symptoms of arterial compro- fects. One could give many more examples. The mise should be evaluated and treated aggressively.
Load more

Recommended publications
  • Study of Brachial Plexus with Regards to Its Formation, Branching Pattern and Variations and Possible Clinical Implications of Those Variations
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 4 Ver. VII (Apr. 2016), PP 23-28 www.iosrjournals.org Study of Brachial Plexus With Regards To Its Formation, Branching Pattern and Variations and Possible Clinical Implications of Those Variations. Dr. Shambhu Prasad1, Dr. Pankaj K Patel2 1 (Assistant Professor , Department of Anatomy , NMCH , Sasaram , India ) 2 (Assistant Professor , Department of Pathology , NMCH , Sasaram , India ) Abstract: Aim of the study: to search variations in formation and branching pattern of brachial plexus and correlate them with possible clinical and surgical implications. Materials and Methods: 25human bodies were dissected for this study. Dissection was started in posterior triangle of neck and extended to distal part of upper limb passing through axilla . Photographs were taken and data was tabulated and analyzed . Observations: All 50 plexuses had origin from C5 – T1 . Dorsal scapular nerve was absent in 2 plexuses. Long thoracic nerve was made of C5,C6 fibers in one and of C6,C7 fibers in another . Lower trunk was abnormal in 2 plexuses both of same body, their was no contribution from T1 fibers to posterior cord in one of these plexus. One plexus had double lateral pectoral nerve , communication between lateral and medial pectoral nerves , lateral pectoral and medial root of median nerve also between musculocutaneous and lateral root of median nerve . 2 more plexuses had communication between lateral and medial pectoral nerves. One plexus showed 2 branches coming from posterior division of upper trunk itself before formation of posterior cord.
    [Show full text]
  • Klippel-Feil Syndrome and Thoracic Outlet Syndrome
    Neurological Disorders & Epilepsy Journal Open Access Clinical Image Klippel-Feil Syndrome and Thoracic Outlet Syndrome Ali Rıza Sonkaya1*, Erkan Kaya2, Serdar Firtina3 and Mehmet AK4 1Department of Neurology, Okmeydam Training and Research Hospital, Turkey 2Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital, Turkey 3Department of Cardiology, Cyprus Military Hospital, Turkey 4Department of Radiology, Ilker Celikcan Physical Medicine and Rehabilitation Hospital, Turkey A R T I C L E I N F O CLINICAL IMAGE Article history: Received: 08 September 2017 Klippel–Feil Syndrome (KFS) is a rare disease that was firstly described in Accepted: 12 October 2017 Published: 18 October 2017 1912 by Maurice Klippel and Andre Feil. It is a bone disorder recognized by the abnormal fusion of two or more spinal bones, it seem in the cervical Copyright: © 2017 Sonkaya AR et al., vertebrae. It has three major features which are short neck, limited age of Neurol Disord Epilepsy J This is an open access article distributed motion in the cervical spine and low hairline at the beck [1]. under the Creative Commons Attribution License, which permits unrestricted use, We report the case of a 26-year-old male patient was admitted to distribution, and reproduction in any medium, provided the original work is cardiology clinic with complaint of left arm and chest pain. Mitral valve properly cited. prolapse detected by transthoracic echocardiography. Patient was referred to Citing this article: Sonkaya AR, Kaya E, Firtina S, Mehmet AK. Klippel-Feil physical therapy and rehabilitation clinic due to cervical scoliosis and the short Syndrome and Thoracic Outlet Syndrome. Neurol Disord Epilepsy J.
    [Show full text]
  • Download PDF File
    Folia Morphol. Vol. 77, No. 2, pp. 386–392 DOI: 10.5603/FM.a2017.0080 O R I G I N A L A R T I C L E Copyright © 2018 Via Medica ISSN 0015–5659 www.fm.viamedica.pl Incidental imaging findings of congenital rib abnormalities: a case series and review of developmental concepts A.M. Aignătoaei1, C.E. Moldoveanu2, I.-D. Căruntu3, S.E. Giuşcă3, S. Partene Vicoleanu3, A.H. Nedelcu3 1Department of Pathology, “Sf. Spiridon” Clinic Hospital, 1, Independenţei Square, Iaşi, Romania 2Department of Radiology, Pneumology Clinic Hospital, 30, dr. Iosif Cihac Street, Iaşi, Romania 3Department of Morphofunctional Sciences, “Grigore T. Popa” University, 16, University Street, Iaşi, Romania [Received: 12 June 2017; Accepted: 24 July 2017] Background: Congenital rib abnormalities are found in approximately 2% of the general population. Usually, they occur in isolation and are rarely symptomatic, but they can also be associated with other malformations. Materials and methods: We reviewed imaging examinations performed over a period of 2 years (2014–2015), enabling us to identify isolated rib abnormalities in 6 adult patients. Results: The case series consisted in 3 cases with bilateral cervical ribs and 1 case each with bifid rib, costal fusion and rib pseudarthrosis. In all patients, the costal anomalies were discovered incidentally. All rib malformations were detected at thoracic radiography, except for the rib pseudarthrosis, which was identified at computed tomography (CT) scan. Differential diagnosis was made between cer- vical ribs and abnormalities of the C7 transverse process and of the first rib, while the other costal malformations were distinguished from tumoural, traumatic or inflammatory lesions of the chest wall, lung and pleura.
    [Show full text]
  • Cubital Tunnel Syndrome)
    DISEASES & CONDITIONS Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome) Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated. The ulnar nerve is one of the three main nerves in your arm. It travels from your neck down into your hand, and can be constricted in several places along the way, such as beneath the collarbone or at the wrist. The most common place for compression of the nerve is behind the inside part of the elbow. Ulnar nerve compression at the elbow is called "cubital tunnel syndrome." Numbness and tingling in the hand and fingers are common symptoms of cubital tunnel syndrome. In most cases, symptoms can be managed with conservative treatments like changes in activities and bracing. If conservative methods do not improve your symptoms, or if the nerve compression is causing muscle weakness or damage in your hand, your doctor may recommend surgery. This illustration of the bones in the shoulder, arm, and hand shows the path of the ulnar nerve. Reproduced from Mundanthanam GJ, Anderson RB, Day C: Ulnar nerve palsy. Orthopaedic Knowledge Online 2009. Accessed August 2011. Anatomy At the elbow, the ulnar nerve travels through a tunnel of tissue (the cubital tunnel) that runs under a bump of bone at the inside of your elbow. This bony bump is called the medial epicondyle. The spot where the nerve runs under the medial epicondyle is commonly referred to as the "funny bone." At the funny bone the nerve is close to your skin, and bumping it causes a shock-like feeling.
    [Show full text]
  • A Narrative Review of Poland's Syndrome
    Review Article A narrative review of Poland’s syndrome: theories of its genesis, evolution and its diagnosis and treatment Eman Awadh Abduladheem Hashim1,2^, Bin Huey Quek1,3,4^, Suresh Chandran1,3,4,5^ 1Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore; 2Department of Neonatology, Salmanya Medical Complex, Manama, Kingdom of Bahrain; 3Department of Neonatology, Duke-NUS Medical School, Singapore, Singapore; 4Department of Neonatology, NUS Yong Loo Lin School of Medicine, Singapore, Singapore; 5Department of Neonatology, NTU Lee Kong Chian School of Medicine, Singapore, Singapore Contributions: (I) Conception and design: EAA Hashim, S Chandran; (II) Administrative support: S Chandran, BH Quek; (III) Provision of study materials: EAA Hashim, S Chandran; (IV) Collection and assembly: All authors; (V) Data analysis and interpretation: BH Quek, S Chandran; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: A/Prof. Suresh Chandran. Senior Consultant, Department of Neonatology, KK Women’s and Children’s Hospital, Singapore 229899, Singapore. Email: [email protected]. Abstract: Poland’s syndrome (PS) is a rare musculoskeletal congenital anomaly with a wide spectrum of presentations. It is typically characterized by hypoplasia or aplasia of pectoral muscles, mammary hypoplasia and variably associated ipsilateral limb anomalies. Limb defects can vary in severity, ranging from syndactyly to phocomelia. Most cases are sporadic but familial cases with intrafamilial variability have been reported. Several theories have been proposed regarding the genesis of PS. Vascular disruption theory, “the subclavian artery supply disruption sequence” (SASDS) remains the most accepted pathogenic mechanism. Clinical presentations can vary in severity from syndactyly to phocomelia in the limbs and in the thorax, rib defects to severe chest wall anomalies with impaired lung function.
    [Show full text]
  • Some Sequels of Abnormality at the Thoracic Outlet* by J
    Thorax: first published as 10.1136/thx.2.1.1 on 1 March 1947. Downloaded from Thorax (1947), 2, 1. SOME SEQUELS OF ABNORMALITY AT THE THORACIC OUTLET* BY J. R. LEARMONTH Edinburgh This paper-on obstruction at the thoracic outlet-deals with the results of anomalies of bone and muscle; first rib, cervical rib, and scaleni. Though thoracic surgeons approach these structures from a different exposure, and with a different end in view, they may be interested in the related types of vascular and nervous disturbance, and may like to compare them with any anomalies thev have encountered in their own operative procedures and which were possibly not associated with clinical symptoms. MORPHOLOGY N~~~~~~~~~~~~~~~~~~~~~~~~1 http://thorax.bmj.com/ The- arrangement of the bones which form the thoracic outlet derives from the typical thoracic segment (Fig. 1). This con- sists of a central piece or centrum (the body of the vertebra) carrying a dorsal and a ventral hoop of bone. The dorsal hoop (neural arch) provides the laminae and spinous process. The central piece or centrum may be defective as on October 3, 2021 by guest. Protected copyright. to one half (hemivertebra), producing both scoliosis and absence of one rib, which inevit- ably alter the architecture of the thoracic out- let on both sides; or it may be fused with adjoining central pieces. The ventral hoop, or haemal arch, is much expanded in the thor- acic region. The haemal arch has a double origin, from a dorsal segment of bone, the pleurapophysis, and a ventral segment, the FIG. 1.-Typical thoracic segment *An address to the Society of Thoracic Surgeons (Owen).
    [Show full text]
  • OMM PRACTICAL EXAM Saroj Misra, DO, FACOFP Rachel Nixon, DO Marissa Rogers, DO Family Medicine Goals/Objectives
    OMM PRACTICAL EXAM Saroj Misra, DO, FACOFP Rachel Nixon, DO Marissa Rogers, DO Family Medicine Goals/Objectives • Review Exam Day procedure • Understand scoring process • Discuss possible cases and 2 OMM techniques that may be used for each case Disclaimer: The material being presented is NOT necessarily identical to what will be tested upon. We are not affiliated with the actual exam. This is our approach to the practical exam material. EXAM DAY Exam day • You will be assigned a time slot based on your last name • You will select a partner within your time slot • May not partner with a spouse or relative • You will be asked to sign a waiver stating that if you choose to do HVLA you will not perform the corrective “thrust” • You will then stand in line with your partner and await entering the testing room Exam day • There will be two rooms - one in which you will review cases and the second where you will be tested • Once you enter the first room you will not be able to leave • If you DO leave, both you and your partner will be given new cases Exam day • You will be given 3 cases: • Spine • Extremities • Systemic Disease • You will enter your name, ID number and your partners ID number on each case before turning them over Exam day • Each case will have the following information: • HPI • PMH • PSH • FHx • SocHx • There will be multiple choice for the best answer for your diagnosis • You will have 20 minutes to choose the best answer and plan a treatment strategy for each of your cases Exam day • After the 20 minutes are complete, you will
    [Show full text]
  • Brachial Plexus Posterior Cord Variability: a Case Report and Review
    CASE REPORT Brachial plexus posterior cord variability: a case report and review Edward O, Arachchi A, Christopher B Edward O, Arachchi A, Christopher B. Brachial plexus posterior cord anatomical variability. This case report details the anatomical variants discovered variability: a case report and review. Int J Anat Var. 2017;10(3):49-50. in the posterior cord of the brachial plexus in a routine cadaveric dissection at the University of Melbourne, Australia. Similar findings in the literature are reviewed ABSTRACT and the clinical significance of these findings is discussed. The formation and distribution of the brachial plexus is a source of great Key Words: Brachial plexus; Posterior cord; Axillary nerve; Anatomical variation INTRODUCTION he brachial plexus is the neural network that supplies motor and sensory Tinnervation to the upper limb. It is typically composed of anterior rami from C5 to T1 spinal segments, which subsequently unite to form superior, middle and inferior trunks. These trunks divide and reunite to form cords 1 surrounding the axillary artery, which terminate in branches of the plexus. The posterior cord is classically described as a union of the posterior divisions from the superior, middle and inferior trunks of the brachial plexus, with fibres from all five spinal segments. The upper subscapular, thoracodorsal and lower subscapular nerves propagate from the cord prior to the axillary and radial nerves forming terminal branches. Variability in the brachial plexus is frequently reported in the literature. It is C5 nerve root Suprascapular nerve important for clinicians to be aware of possible variations when considering Posterior division of C5-C6 injuries or disease of the upper limb.
    [Show full text]
  • 1 the Thoracic Wall I
    AAA_C01 12/13/05 10:29 Page 8 1 The thoracic wall I Thoracic outlet (inlet) First rib Clavicle Suprasternal notch Manubrium 5 Third rib 1 2 Body of sternum Intercostal 4 space Xiphisternum Scalenus anterior Brachial Cervical Costal cartilage plexus rib Costal margin 3 Subclavian 1 Costochondral joint Floating ribs artery 2 Sternocostal joint Fig.1.3 3 Interchondral joint Bilateral cervical ribs. 4 Xiphisternal joint 5 Manubriosternal joint On the right side the brachial plexus (angle of Louis) is shown arching over the rib and stretching its lowest trunk Fig.1.1 The thoracic cage. The outlet (inlet) of the thorax is outlined Transverse process with facet for rib tubercle Demifacet for head of rib Head Neck Costovertebral T5 joint T6 Facet for Tubercle vertebral body Costotransverse joint Sternocostal joint Shaft 6th Angle rib Costochondral Subcostal groove joint Fig.1.2 Fig.1.4 A typical rib Joints of the thoracic cage 8 The thorax The thoracic wall I AAA_C01 12/13/05 10:29 Page 9 The thoracic cage Costal cartilages The thoracic cage is formed by the sternum and costal cartilages These are bars of hyaline cartilage which connect the upper in front, the vertebral column behind and the ribs and intercostal seven ribs directly to the sternum and the 8th, 9th and 10th ribs spaces laterally. to the cartilage immediately above. It is separated from the abdominal cavity by the diaphragm and communicates superiorly with the root of the neck through Joints of the thoracic cage (Figs 1.1 and 1.4) the thoracic inlet (Fig.
    [Show full text]
  • Neurogenic Thoracic Outlet Syndrome
    NEUROGENIC THORACIC OUTLET SYNDROME Karl A. Illig, MD, and Mathew Wooster, MD Perhaps no condition treated by vascular surgeons has been up undergoing thoracic outlet decompression. Although associated with more confusion, subjectivity, and nihilism at least two high outliers exist (Denver and St. Louis, with than neurogenic thoracic outlet syndrome (NTOS). Why is UCLA, Johns Hopkins, and several other practices also candi- this, a nerve compression syndrome, even treated by vascular dates), it is estimated that the 10 or 15 high-volume American surgeons? How is it diagnosed, and what other conditions TOS centers perform between 30 and 50 first rib excisions mimic its symptoms? Who should undergo treatment, and yearly, 75% or so for neurogenic symptoms. what exactly does treatment consist of? Is it a real entity or Although several notable thoracic surgeons and neuro- simply just one end of a continuum that is probably just a part surgeons have significant interest in NTOS, the vast majority of normal physiology? of these cases are treated by vascular surgeons. The reasons are The thoracic outlet is the area of the body at the base of the obscure, but almost certainly a large part of this arose from the neck and upper chest and shoulder region that contains the fact that “vascular” TOS —arterial and, more recently, venous nerves, artery, and vein as they pass from the upper extrem- pathology—was the first form to be recognized, and vascular ity to the spine and thorax [see Figure 1]. Each of these three surgeons initiated investigation and treatment of problems in structures can be compressed by abnormal anatomy in one of this area.
    [Show full text]
  • A Comprehensive Review of Anatomy and Regional Anesthesia Techniques of Clavicle Surgeries
    vv ISSN: 2641-3116 DOI: https://dx.doi.org/10.17352/ojor CLINICAL GROUP Received: 31 March, 2021 Research Article Accepted: 07 April, 2021 Published: 10 April, 2021 *Corresponding author: Dr. Kartik Sonawane, Uncovering secrets of the Junior Consultant, Department of Anesthesiol- ogy, Ganga Medical Centre & Hospitals, Pvt. Ltd. Coimbatore, Tamil Nadu, India, E-mail: beauty bone: A comprehensive Keywords: Clavicle fractures; Floating shoulder sur- gery; Clavicle surgery; Clavicle anesthesia; Procedure review of anatomy and specific anesthesia; Clavicular block regional anesthesia techniques https://www.peertechzpublications.com of clavicle surgeries Kartik Sonawane1*, Hrudini Dixit2, J.Balavenkatasubramanian3 and Palanichamy Gurumoorthi4 1Junior Consultant, Department of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India 2Fellow in Regional Anesthesia, Department of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India 3Senior Consultant, Department of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India 4Consultant, Department of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India Abstract The clavicle is the most frequently fractured bone in humans. General anesthesia with or without Regional Anesthesia (RA) is most frequently used for clavicle surgeries due to its complex innervation. Many RA techniques, alone or in combination, have been used for clavicle surgeries. These include interscalene block, cervical plexus (superficial and deep) blocks, SCUT (supraclavicular nerve + selective upper trunk) block, and pectoral nerve blocks (PEC I and PEC II). The clavipectoral fascial plane block is also a safe and simple option and replaces most other RA techniques due to its lack of side effects like phrenic nerve palsy or motor block of the upper limb.
    [Show full text]
  • Csph0114 V1 Nov19 Ulnar Nerve A4.Pmd
    What is an Ulnar Nerve Entrapment? Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated. The ulnar nerve is one of the three main nerves in your arm. It travels from your neck down into your hand and can be constricted in several places along the way, such as underneath the collarbone or at the wrist. The most common place for compression of the nerve is the inside of the elbow. Ulnar nerve compression at the elbow is called “cubital tunnel syndrome.” In many cases of cubital tunnel syndrome, the exact cause is not known. The ulnar nerve is especially vulnerable to compression at the elbow because it must travel through a narrow space with very little soft tissue to protect it. Diagram with the permission of American Academy of Orthopaedic Surgeons (AAOS) What are the symptoms? • Aching pain on the inside of the elbow. Most of the symptoms, however, occur in your hand. • Numbness and tingling in the ring finger and little finger are common. Often, these symptoms come and go. They happen more often when the elbow is bent, such as when driving or holding the phone. Some people wake up at night because their fingers are numb. • Weakening of the grip and difficulty with finger coordination (such as typing or playing an instrument) may occur. • In later stages, the numbness is constant and the hand becomes weaker. There may be a visible loss of muscle bulk in severe cases, particularly noticeable on the back of the hand between the thumb and first finger, with loss of strength and dexterity Who gets it? People that have: • Prior fracture or dislocations of the elbow • Bone spurs/ arthritis of the elbow • Swelling of the elbow joint • Cysts near the elbow joint • An occupation or activities that require the elbow to be bent or flexed Leaflet No: csph0114 v1 Review Date 11/19 Page 1 of 2 Things that can help relieve the symptoms Rest and activity modification - Overuse of the affected hand and elbow can often result in an increase in your symptoms.
    [Show full text]