Thoracic Outlet Syndrome and dysfunction of the temporomandibular joint

SENDA Masuo, HAMADA Masanori, KATAYAMA Yoshimi, TSUKIYAMA Naosi

doi:10.7144/sgf.10.7

Chief complaints of Patients with thoracic outlet syndrome (TOS) are pain, numbness, and dullness at their neck, shoulder or upper extremity. Such symptoms result from compression or traction of the neurovascular bundle through the thoracic outlet. The entrapment of the neurovascular bundle may be caused by a cervical rib, by hypertrophy or spasm of the scalenus anterior, by abnormal droop of the shoulder girdle, by spasm of the scalenus medius secondary trauma or abnormal posture, by anomalies of the first rib, by abnormal tension of the pectoralis minor. In tempromandibular disorder (TMD), patients often compliant neck stiffness. The neck muscles of the patients with TMD, for example scalenus anterior and scalenus medius, become so stiff that the thoracic outlet may be narrow. The patients with TMD easily suffer from TOS at the same time. We have to be able to diagnose TOS when the patients with TMD complain of pain, numbness, and dullness at their neck, shoulder or upper extremity. In order to diagnose TOS, useful clinical tests, Adson test, Wright test, Eden test, Allen test, Morley test, and Roos test are explained. And new methods to diagnose TOS, somatosensory evoked potential (SSEP), F-wave, brachial plexus neurography, and MRI are introduced. Conservative treatments of TOS are described, for example muscle exercise around the neck and shoulder, stretching, relaxation, and arthrokinetic approach (AKA) . Surgical methods are rare to treat TOS, and the most effective operation is decompression of the neurovascular bundle by resection of the first rib and anomalous structures.

Thoracic Outlet Syndrome and dysfunction of the temporomandibular joint

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