Differentiation of thoracic outlet syndrome from treatment-resistant cervical brachial pain syndromes: development and utilization of a questionnaire, clinical examination and ultrasound evaluation.

1: Pain Physician. 2007 May;10(3):441-52.

Jordan SE, Ahn SS, Gelabert HA.

Neurological Associates of West Los Angeles, Santa Monica, CA and UCLA Department of Vascular Surgery, Los Angeles, CA.

OBJECTIVE: The present study was undertaken to determine which factors differentiate patients with a good outcome after treatment for Thoracic Outlet Syndrome (TOS) from patients with a poor outcome.

METHODS: A total of 85 patients, who were examined during one year, had at least 6 months of follow up after treatment for TOS with either surgery or botulinum chemodenervation.

RSULTS: Socioeconomic factors of work disability or workers’ compensation claims did not differentiate treatment-responsive TOS from treatment-resistant cases. There was no difference between the 2 groups regarding the presence of anomalous anatomy detected by ultrasonography or regarding the presence of subclavian artery flow acceleration or occlusion detected by duplex sonography. Several factors were noted more frequently in treatment-resistant patients: sensory complaints extending beyond lower trunk dermatomes (42% vs. 10%), weakness extending beyond lower trunk myotomes (19% vs. 2%), histories of previous non-TOS surgery of the neck or upper limbs (50% vs.17%), comorbidities of fibromyalgia or complex regional pain syndrome (81% vs. 12%), and depression (35% vs. 10%). Treatment-resistant patients complained about more widespread functional impairments on a validated Cervical Brachial Symptom Questionnaire (CBSQ) than treatment-responsive patients. Resistant cases responded less often to a scalene test block (38% vs. 100%), which is designed to simulate the effects of targeted treatment.

CONCLUSION: In summary, compared to patients with a good outcome after targeted treatment, patients with a poor outcome had more diffuse complaints and responded less often to a scalene test block.

PMID: 17525778 [PubMed – in process]

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Folllowing Rick Usher's death in December 2008, at his request in September of that year, I had agreed, as his principal contributor and an experienced journalist, to run the FMS Global News service due to his heavy commitments to music and raising research funds through this avenue. Following his sad and sudden death I hope to continue his work as he would have wished.
This entry was posted in Analgesics, Article, Autoimmune Diseases, Back Pain, Boston, Britain, Central Nervous System, Chronic Multisymptom Illness, Chronic Myofacial Pain, Chronic Pain, Chronic Pain Disorders, Chronic Widespread Pain, Clinical, Clinical Pain, Diseases, Dysfunctional Pain Processing, Europe, Fatigue, Feeds, Fibrohugs, Fibrohugs News, Fibromyalgia, Fibromyalgia Blogs, Fibromyalgia News, Fibromyalgia News Belgium, Fibromyalgia News Deutschland, Fibromyalgia News France, Fibromyalgia News Israel, Fibromyalgia News Italy, Fibromyalgia News Japan, Fibromyalgia News Jerusalem, Fibromyalgia News Korea, Fibromyalgia News Southeast Asia, Fibromyalgia News Turkey, Fibromyalgia News Wisconsin, Fibromyalia News Germany, FMS Global News, Global News, Medical, Medical Research, Medical University, Myofacial Pain Syndrome, News, News Australia, News Belgium, News Canada, News France, News India, News Ireland, News Israel, News Italy, News Japan, News Jerusalem, News Korea, News Montreal, News Nigeria, News Norway, News Quebec, News Saskatchewan, News Scotland, News Spain, News Sweden, News Toronto, News Turkey, News UK, News Wisconsin, Nigeria, North Carolina, Ontario, Ottawa, Pain, Pain Management, Pain Management Clinic, Pain Matrix, Philadelphia, Research, RSS, Swedish, Tenderpoints, Therapies, Toronto, Universities, US, Virginia, Washington DC, World, World News. Bookmark the permalink.

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