SlideShare a Scribd company logo
Unilateral Arm Swelling
Tim Kubal
Venogram
ProvocativeVenogram
Thoracic Outlet
Syndrome
• Compression of neurovascular structures
as they pass through the thoracic outlet.
• NTOS,ATOS,VTOS (Paget-Schroetter
Syndrome)
• Whiplash, Repetitive activity, rib anomaly,
prior clavicular fx, fibrosis.
Anatomy
NTOS
• Most common with the majority of these
cases being related to trauma and virtually
impossible to diagnose objectively
• Paresthesias, pain
• Tx conservatively in majority of cases
unless demonstrable anatomical
abnormality then consider surgery
VTOS
• Majority of cases related to strenuous or
repetitive overhead activity.
• Acute or subacute swelling, heaviness, pain,
venous distention with visible collaterals.
• Acute: Thrombolytics, stenting/venoplasty,
surgical decompression, anticoagulation.
• Subacute: Conservative vs. Surgery
ATOS
• Least common
• Subclavian Artery Compression
• Typically secondary to demonstrable rib
abnormality
• Pain, Paresthesias, Cyanosis, Embolism,
Negative Pulses, Slow capillary refill
How do i work this up?
• Provocative testing
• Dopplers (Acutely r/o thrombosis)
• C-Spine films, shoulder films
• CT chest
Management
• VTOS: Usually requires urgent
thrombolysis, anticoag, surgical
decompressions
• ATOS: surgical decompression and
restoration of arterial blood flow
• NTOS: PT, surgical decompression.
Surgery
• Rib, muscle resection
• Less stuff
• More space
What else could it be?
• Brachial plexus injury
• Carpal Tunnel
• CRPS
• Malignancy
• C-Spine or shoulder MSK
• Nothing
TOS
• JR Richard (CVA)
• David Cone (Arterial aneurysm)
• Hanson

More Related Content

What's hot

Chronic limb ischemia
Chronic limb ischemiaChronic limb ischemia
Chronic limb ischemia
Dr Slayer
 
Acute Limb Ischemia
Acute Limb IschemiaAcute Limb Ischemia
Acute Limb Ischemia
Sun Yai-Cheng
 
Vascular trauma
Vascular traumaVascular trauma
Vascular trauma
AMNCH Vascular Surgery
 
Arterial trauma
Arterial traumaArterial trauma
Vascular Surgery - Surgery under critical environmental conditions
Vascular Surgery - Surgery under critical environmental conditionsVascular Surgery - Surgery under critical environmental conditions
Vascular Surgery - Surgery under critical environmental conditions
Global Risk Forum GRFDavos
 
Lower Limb Vascular Trauma
Lower  Limb  Vascular  TraumaLower  Limb  Vascular  Trauma
Lower Limb Vascular TraumaSaeed Al-Shomimi
 
Acute limb ischemia
Acute limb ischemiaAcute limb ischemia
Acute limb ischemia
Abhilash Cheriyan
 
Vascular Emergencies
Vascular EmergenciesVascular Emergencies
Vascular Emergencies
Steve Henao MD FACS FACC
 
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
College of Medicine, Sulaymaniyah
 
Nursing Care of Clients with Peripheral Vascular Disorders Part 3 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 3 of 3 Nursing Care of Clients with Peripheral Vascular Disorders Part 3 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 3 of 3
Carmela Domocmat
 
Chronic limb ischaemia
Chronic limb ischaemiaChronic limb ischaemia
Chronic limb ischaemia
Chea Chan Hooi
 
Arterial injuries
Arterial injuriesArterial injuries
Arterial injuries
NRI MEDICAL COLLEGE
 
Vastrauma mannar
Vastrauma mannarVastrauma mannar
Emergencies in vascular surgery
Emergencies in vascular  surgery Emergencies in vascular  surgery
Emergencies in vascular surgery
Joel Arudchelvam MBBS, MD, MRCS, FCSSL
 
Acute limb ischemia
Acute limb ischemiaAcute limb ischemia
Acute limb ischemia
Abino David
 
Abdominal aortic aneurysm
Abdominal aortic aneurysm Abdominal aortic aneurysm
Abdominal aortic aneurysm
LadyKFI
 
Acute limb ischaemia
Acute limb ischaemiaAcute limb ischaemia
Acute limb ischaemia
Kunwar Saurabh
 
Acute Limb ischemia
Acute Limb ischemiaAcute Limb ischemia
Acute Limb ischemia
HamzehKYacoub
 
Acute limb ischaemia
Acute limb ischaemiaAcute limb ischaemia
Acute limb ischaemia
Sumer Yadav
 
Aneurysm
AneurysmAneurysm
Aneurysm
Jinumol Jacob
 

What's hot (20)

Chronic limb ischemia
Chronic limb ischemiaChronic limb ischemia
Chronic limb ischemia
 
Acute Limb Ischemia
Acute Limb IschemiaAcute Limb Ischemia
Acute Limb Ischemia
 
Vascular trauma
Vascular traumaVascular trauma
Vascular trauma
 
Arterial trauma
Arterial traumaArterial trauma
Arterial trauma
 
Vascular Surgery - Surgery under critical environmental conditions
Vascular Surgery - Surgery under critical environmental conditionsVascular Surgery - Surgery under critical environmental conditions
Vascular Surgery - Surgery under critical environmental conditions
 
Lower Limb Vascular Trauma
Lower  Limb  Vascular  TraumaLower  Limb  Vascular  Trauma
Lower Limb Vascular Trauma
 
Acute limb ischemia
Acute limb ischemiaAcute limb ischemia
Acute limb ischemia
 
Vascular Emergencies
Vascular EmergenciesVascular Emergencies
Vascular Emergencies
 
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
 
Nursing Care of Clients with Peripheral Vascular Disorders Part 3 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 3 of 3 Nursing Care of Clients with Peripheral Vascular Disorders Part 3 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 3 of 3
 
Chronic limb ischaemia
Chronic limb ischaemiaChronic limb ischaemia
Chronic limb ischaemia
 
Arterial injuries
Arterial injuriesArterial injuries
Arterial injuries
 
Vastrauma mannar
Vastrauma mannarVastrauma mannar
Vastrauma mannar
 
Emergencies in vascular surgery
Emergencies in vascular  surgery Emergencies in vascular  surgery
Emergencies in vascular surgery
 
Acute limb ischemia
Acute limb ischemiaAcute limb ischemia
Acute limb ischemia
 
Abdominal aortic aneurysm
Abdominal aortic aneurysm Abdominal aortic aneurysm
Abdominal aortic aneurysm
 
Acute limb ischaemia
Acute limb ischaemiaAcute limb ischaemia
Acute limb ischaemia
 
Acute Limb ischemia
Acute Limb ischemiaAcute Limb ischemia
Acute Limb ischemia
 
Acute limb ischaemia
Acute limb ischaemiaAcute limb ischaemia
Acute limb ischaemia
 
Aneurysm
AneurysmAneurysm
Aneurysm
 

Viewers also liked

Entrapment neuropathies 28.2.12
Entrapment neuropathies 28.2.12Entrapment neuropathies 28.2.12
Entrapment neuropathies 28.2.12
nagarjunmn
 
Dente ppdoc copia
Dente ppdoc copiaDente ppdoc copia
Dente ppdoc copia
silversurfer467
 
Kin 188 Shoulder Evaluation And Injuries
Kin 188  Shoulder Evaluation And InjuriesKin 188  Shoulder Evaluation And Injuries
Kin 188 Shoulder Evaluation And InjuriesJLS10
 
SVS- Thoracic Outlet Syndrome Presentation
SVS- Thoracic Outlet Syndrome PresentationSVS- Thoracic Outlet Syndrome Presentation
SVS- Thoracic Outlet Syndrome Presentationvma1082
 
Brachial plexus injury and Thoracic outlet syndromes
Brachial plexus injury and Thoracic outlet syndromesBrachial plexus injury and Thoracic outlet syndromes
Brachial plexus injury and Thoracic outlet syndromes
Bhavin Mandowara
 
Management of primary bone tumours
Management of primary bone tumoursManagement of primary bone tumours
Management of primary bone tumoursNOHD, Kano, Nigeria
 
muscle s of upper limb
muscle s of upper limbmuscle s of upper limb
muscle s of upper limbNaresh Odnala
 
Painful Conditions of the Shoulder by: Dr. Craig Arntz
Painful Conditions of the Shoulder by: Dr. Craig Arntz Painful Conditions of the Shoulder by: Dr. Craig Arntz
Painful Conditions of the Shoulder by: Dr. Craig Arntz
VOA
 
Lecture Two chapter 2 and 3 (#3) posted PPP
Lecture Two chapter 2 and 3 (#3) posted PPPLecture Two chapter 2 and 3 (#3) posted PPP
Lecture Two chapter 2 and 3 (#3) posted PPPCharles Curtis
 
Thoracic cavity Relationship
Thoracic cavity RelationshipThoracic cavity Relationship
Thoracic cavity Relationship
Mahamad Jamal
 
Principles of management of malignant bone tumours
Principles of management of malignant bone tumoursPrinciples of management of malignant bone tumours
Principles of management of malignant bone tumours
Soliudeen Arojuraye
 
Upper limb nerve injuries
Upper limb nerve injuriesUpper limb nerve injuries
Upper limb nerve injuries
Muhammad Ramzan Ul Rehman
 
Anatomy revision 2
Anatomy revision 2Anatomy revision 2
Anatomy revision 2
Murad Alshehry
 
Piriformis syndrome
Piriformis syndromePiriformis syndrome
Piriformis syndromeAndy Coleman
 
Presentation2.pptx bone tumour
Presentation2.pptx bone tumourPresentation2.pptx bone tumour
Presentation2.pptx bone tumourAbdellah Nazeer
 
Clinical assessment of the rotator cuff
Clinical assessment of the rotator cuffClinical assessment of the rotator cuff
Clinical assessment of the rotator cuff
Wrightington Upper Limb Unit
 
Thoracic outlet syndrome
Thoracic outlet syndromeThoracic outlet syndrome
Thoracic outlet syndrome
Jasmin Mohammed
 
Muscles and Topography of the Upper and Lower Limb
Muscles and Topography  of the Upper and Lower LimbMuscles and Topography  of the Upper and Lower Limb
Muscles and Topography of the Upper and Lower Limb
MBBS Help
 

Viewers also liked (20)

Entrapment neuropathies 28.2.12
Entrapment neuropathies 28.2.12Entrapment neuropathies 28.2.12
Entrapment neuropathies 28.2.12
 
Dente ppdoc copia
Dente ppdoc copiaDente ppdoc copia
Dente ppdoc copia
 
Kin 188 Shoulder Evaluation And Injuries
Kin 188  Shoulder Evaluation And InjuriesKin 188  Shoulder Evaluation And Injuries
Kin 188 Shoulder Evaluation And Injuries
 
Brachial plexus
Brachial plexusBrachial plexus
Brachial plexus
 
SVS- Thoracic Outlet Syndrome Presentation
SVS- Thoracic Outlet Syndrome PresentationSVS- Thoracic Outlet Syndrome Presentation
SVS- Thoracic Outlet Syndrome Presentation
 
Brachial plexus injury and Thoracic outlet syndromes
Brachial plexus injury and Thoracic outlet syndromesBrachial plexus injury and Thoracic outlet syndromes
Brachial plexus injury and Thoracic outlet syndromes
 
Management of primary bone tumours
Management of primary bone tumoursManagement of primary bone tumours
Management of primary bone tumours
 
muscle s of upper limb
muscle s of upper limbmuscle s of upper limb
muscle s of upper limb
 
Painful Conditions of the Shoulder by: Dr. Craig Arntz
Painful Conditions of the Shoulder by: Dr. Craig Arntz Painful Conditions of the Shoulder by: Dr. Craig Arntz
Painful Conditions of the Shoulder by: Dr. Craig Arntz
 
Lecture Two chapter 2 and 3 (#3) posted PPP
Lecture Two chapter 2 and 3 (#3) posted PPPLecture Two chapter 2 and 3 (#3) posted PPP
Lecture Two chapter 2 and 3 (#3) posted PPP
 
Thoracic cavity Relationship
Thoracic cavity RelationshipThoracic cavity Relationship
Thoracic cavity Relationship
 
Aproach to bone tumours
Aproach to bone   tumoursAproach to bone   tumours
Aproach to bone tumours
 
Principles of management of malignant bone tumours
Principles of management of malignant bone tumoursPrinciples of management of malignant bone tumours
Principles of management of malignant bone tumours
 
Upper limb nerve injuries
Upper limb nerve injuriesUpper limb nerve injuries
Upper limb nerve injuries
 
Anatomy revision 2
Anatomy revision 2Anatomy revision 2
Anatomy revision 2
 
Piriformis syndrome
Piriformis syndromePiriformis syndrome
Piriformis syndrome
 
Presentation2.pptx bone tumour
Presentation2.pptx bone tumourPresentation2.pptx bone tumour
Presentation2.pptx bone tumour
 
Clinical assessment of the rotator cuff
Clinical assessment of the rotator cuffClinical assessment of the rotator cuff
Clinical assessment of the rotator cuff
 
Thoracic outlet syndrome
Thoracic outlet syndromeThoracic outlet syndrome
Thoracic outlet syndrome
 
Muscles and Topography of the Upper and Lower Limb
Muscles and Topography  of the Upper and Lower LimbMuscles and Topography  of the Upper and Lower Limb
Muscles and Topography of the Upper and Lower Limb
 

Similar to 1.13.10 kubal thoracic outlet syndrome

thoracic outlet syndrome
thoracic outlet syndromethoracic outlet syndrome
thoracic outlet syndrome
GIRIDHAR BOYAPATI
 
Thoracic outlet syndrome
Thoracic outlet syndromeThoracic outlet syndrome
Thoracic outlet syndrome
K KHAING SAW LWIN
 
12 cardio-infectious
12  cardio-infectious12  cardio-infectious
12 cardio-infectious
Bea Galang
 
THORACIC%20OUTLET%20SYNDROME.pptx
THORACIC%20OUTLET%20SYNDROME.pptxTHORACIC%20OUTLET%20SYNDROME.pptx
THORACIC%20OUTLET%20SYNDROME.pptx
NEELESHCHOUDHARY4
 
Thoracic outlet syndrome
Thoracic outlet syndromeThoracic outlet syndrome
Thoracic outlet syndrome
Mahesh Raj
 
Spinal stenosis
Spinal stenosisSpinal stenosis
Spinal stenosis
Mukhtar Khan
 
Compartment Syndrome.pptx
Compartment Syndrome.pptxCompartment Syndrome.pptx
Compartment Syndrome.pptx
AsyrafulMuhammad1
 
Cervical rib syndrome
Cervical rib syndromeCervical rib syndrome
Cervical rib syndrome
Dr Prabhu Dayal Sinwar
 
Av fistula.pptx
Av fistula.pptxAv fistula.pptx
Av fistula.pptx
Pradeep Pande
 
Chest Pain.pptx
Chest Pain.pptxChest Pain.pptx
Chest Pain.pptx
prabhatbhati3
 
Radiological approach to aortic aneurysm and acute diseases
Radiological approach to aortic aneurysm and acute diseasesRadiological approach to aortic aneurysm and acute diseases
Radiological approach to aortic aneurysm and acute diseases
Milan Silwal
 
Trauma Presentation
Trauma PresentationTrauma Presentation
Trauma Presentation
tomcpitts
 
Musculoskeletal trauma - dr. Hendy .ppt
Musculoskeletal trauma - dr. Hendy .pptMusculoskeletal trauma - dr. Hendy .ppt
Musculoskeletal trauma - dr. Hendy .ppt
HendyLubis1
 
Thoracic outlet syndrome
Thoracic outlet syndromeThoracic outlet syndrome
Thoracic outlet syndrome
Mahak Jain
 
Thoraco Lumbar Spine Injury
Thoraco Lumbar Spine InjuryThoraco Lumbar Spine Injury
Thoraco Lumbar Spine Injury
Kevin Ambadan
 
Arterial diseases by Dr. AmrithaAnilkumar
Arterial diseases by Dr. AmrithaAnilkumarArterial diseases by Dr. AmrithaAnilkumar
Arterial diseases by Dr. AmrithaAnilkumar
Dr. Amritha Anilkumar
 
2_2019_11_15!10_08_04444444444441_AM.ppt
2_2019_11_15!10_08_04444444444441_AM.ppt2_2019_11_15!10_08_04444444444441_AM.ppt
2_2019_11_15!10_08_04444444444441_AM.ppt
Anjum Raashid
 
ANUERYSMS ,AV FISTULAS ,ARTERISTIS ,RAYNAUDS DISEASE -1.pptx
ANUERYSMS ,AV FISTULAS ,ARTERISTIS ,RAYNAUDS DISEASE -1.pptxANUERYSMS ,AV FISTULAS ,ARTERISTIS ,RAYNAUDS DISEASE -1.pptx
ANUERYSMS ,AV FISTULAS ,ARTERISTIS ,RAYNAUDS DISEASE -1.pptx
musayansa
 
seronegative spondyloarthropaty.pptx
seronegative spondyloarthropaty.pptxseronegative spondyloarthropaty.pptx
seronegative spondyloarthropaty.pptx
Kishore Vemula
 

Similar to 1.13.10 kubal thoracic outlet syndrome (20)

thoracic outlet syndrome
thoracic outlet syndromethoracic outlet syndrome
thoracic outlet syndrome
 
Síndrome aórtico agudo
Síndrome  aórtico  agudoSíndrome  aórtico  agudo
Síndrome aórtico agudo
 
Thoracic outlet syndrome
Thoracic outlet syndromeThoracic outlet syndrome
Thoracic outlet syndrome
 
12 cardio-infectious
12  cardio-infectious12  cardio-infectious
12 cardio-infectious
 
THORACIC%20OUTLET%20SYNDROME.pptx
THORACIC%20OUTLET%20SYNDROME.pptxTHORACIC%20OUTLET%20SYNDROME.pptx
THORACIC%20OUTLET%20SYNDROME.pptx
 
Thoracic outlet syndrome
Thoracic outlet syndromeThoracic outlet syndrome
Thoracic outlet syndrome
 
Spinal stenosis
Spinal stenosisSpinal stenosis
Spinal stenosis
 
Compartment Syndrome.pptx
Compartment Syndrome.pptxCompartment Syndrome.pptx
Compartment Syndrome.pptx
 
Cervical rib syndrome
Cervical rib syndromeCervical rib syndrome
Cervical rib syndrome
 
Av fistula.pptx
Av fistula.pptxAv fistula.pptx
Av fistula.pptx
 
Chest Pain.pptx
Chest Pain.pptxChest Pain.pptx
Chest Pain.pptx
 
Radiological approach to aortic aneurysm and acute diseases
Radiological approach to aortic aneurysm and acute diseasesRadiological approach to aortic aneurysm and acute diseases
Radiological approach to aortic aneurysm and acute diseases
 
Trauma Presentation
Trauma PresentationTrauma Presentation
Trauma Presentation
 
Musculoskeletal trauma - dr. Hendy .ppt
Musculoskeletal trauma - dr. Hendy .pptMusculoskeletal trauma - dr. Hendy .ppt
Musculoskeletal trauma - dr. Hendy .ppt
 
Thoracic outlet syndrome
Thoracic outlet syndromeThoracic outlet syndrome
Thoracic outlet syndrome
 
Thoraco Lumbar Spine Injury
Thoraco Lumbar Spine InjuryThoraco Lumbar Spine Injury
Thoraco Lumbar Spine Injury
 
Arterial diseases by Dr. AmrithaAnilkumar
Arterial diseases by Dr. AmrithaAnilkumarArterial diseases by Dr. AmrithaAnilkumar
Arterial diseases by Dr. AmrithaAnilkumar
 
2_2019_11_15!10_08_04444444444441_AM.ppt
2_2019_11_15!10_08_04444444444441_AM.ppt2_2019_11_15!10_08_04444444444441_AM.ppt
2_2019_11_15!10_08_04444444444441_AM.ppt
 
ANUERYSMS ,AV FISTULAS ,ARTERISTIS ,RAYNAUDS DISEASE -1.pptx
ANUERYSMS ,AV FISTULAS ,ARTERISTIS ,RAYNAUDS DISEASE -1.pptxANUERYSMS ,AV FISTULAS ,ARTERISTIS ,RAYNAUDS DISEASE -1.pptx
ANUERYSMS ,AV FISTULAS ,ARTERISTIS ,RAYNAUDS DISEASE -1.pptx
 
seronegative spondyloarthropaty.pptx
seronegative spondyloarthropaty.pptxseronegative spondyloarthropaty.pptx
seronegative spondyloarthropaty.pptx
 

Recently uploaded

Evaluation of antidepressant activity of clitoris ternatea in animals
Evaluation of antidepressant activity of clitoris ternatea in animalsEvaluation of antidepressant activity of clitoris ternatea in animals
Evaluation of antidepressant activity of clitoris ternatea in animals
Shweta
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
VarunMahajani
 
micro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdfmicro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdf
Anurag Sharma
 
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptxTriangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
heat stroke and heat exhaustion in children
heat stroke and heat exhaustion in childrenheat stroke and heat exhaustion in children
heat stroke and heat exhaustion in children
SumeraAhmad5
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
KafrELShiekh University
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
Dr. Vinay Pareek
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
Catherine Liao
 
Physiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of TastePhysiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of Taste
MedicoseAcademics
 
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
Catherine Liao
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
NephroTube - Dr.Gawad
 
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
bkling
 
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Oleg Kshivets
 
Antiulcer drugs Advance Pharmacology .pptx
Antiulcer drugs Advance Pharmacology .pptxAntiulcer drugs Advance Pharmacology .pptx
Antiulcer drugs Advance Pharmacology .pptx
Rohit chaurpagar
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
Swetaba Besh
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
Little Cross Family Clinic
 
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury  ppt  Upendra pal  optometrist upums saifai etawahOcular injury  ppt  Upendra pal  optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawah
pal078100
 
Physiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdfPhysiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdf
MedicoseAcademics
 
KDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologistsKDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologists
د.محمود نجيب
 

Recently uploaded (20)

Evaluation of antidepressant activity of clitoris ternatea in animals
Evaluation of antidepressant activity of clitoris ternatea in animalsEvaluation of antidepressant activity of clitoris ternatea in animals
Evaluation of antidepressant activity of clitoris ternatea in animals
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
 
micro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdfmicro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdf
 
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptxTriangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
 
heat stroke and heat exhaustion in children
heat stroke and heat exhaustion in childrenheat stroke and heat exhaustion in children
heat stroke and heat exhaustion in children
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
 
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
 
Physiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of TastePhysiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of Taste
 
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
 
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
 
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
 
Antiulcer drugs Advance Pharmacology .pptx
Antiulcer drugs Advance Pharmacology .pptxAntiulcer drugs Advance Pharmacology .pptx
Antiulcer drugs Advance Pharmacology .pptx
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
 
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury  ppt  Upendra pal  optometrist upums saifai etawahOcular injury  ppt  Upendra pal  optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawah
 
Physiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdfPhysiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdf
 
KDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologistsKDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologists
 

1.13.10 kubal thoracic outlet syndrome

  • 4. Thoracic Outlet Syndrome • Compression of neurovascular structures as they pass through the thoracic outlet. • NTOS,ATOS,VTOS (Paget-Schroetter Syndrome) • Whiplash, Repetitive activity, rib anomaly, prior clavicular fx, fibrosis.
  • 6. NTOS • Most common with the majority of these cases being related to trauma and virtually impossible to diagnose objectively • Paresthesias, pain • Tx conservatively in majority of cases unless demonstrable anatomical abnormality then consider surgery
  • 7. VTOS • Majority of cases related to strenuous or repetitive overhead activity. • Acute or subacute swelling, heaviness, pain, venous distention with visible collaterals. • Acute: Thrombolytics, stenting/venoplasty, surgical decompression, anticoagulation. • Subacute: Conservative vs. Surgery
  • 8. ATOS • Least common • Subclavian Artery Compression • Typically secondary to demonstrable rib abnormality • Pain, Paresthesias, Cyanosis, Embolism, Negative Pulses, Slow capillary refill
  • 9. How do i work this up? • Provocative testing • Dopplers (Acutely r/o thrombosis) • C-Spine films, shoulder films • CT chest
  • 10. Management • VTOS: Usually requires urgent thrombolysis, anticoag, surgical decompressions • ATOS: surgical decompression and restoration of arterial blood flow • NTOS: PT, surgical decompression.
  • 11. Surgery • Rib, muscle resection • Less stuff • More space
  • 12. What else could it be? • Brachial plexus injury • Carpal Tunnel • CRPS • Malignancy • C-Spine or shoulder MSK • Nothing
  • 13. TOS • JR Richard (CVA) • David Cone (Arterial aneurysm) • Hanson