The enigma of neurogenic thoracic outlet syndrome following motor vehicle collisions

The enigma of neurogenic thoracic outlet syndrome following motor vehicle collisions

Can J Surg 2016;59(4):276-80 | PDF

A. Ian Munro, MBBS; G. Duncan McPherson, MD, PhD

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.

Résumé

Contexte : Il n’y a pas consensus sur le concept de syndrome du défilé thoraco-brachial (SDTB) neurogène comprenant des syndromes du plexus brachial inférieur et supérieur consécutifs à une blessure aux tissus mous du cou découlant d’une collision de véhicules motorisés. Nous avons pensé que l’analyse de données objectives sur les patients touchés pourrait aider à comprendre ce type controversé de SDTB neurogène.

Méthodes : Durant une période de 10 ans, soit de janvier 2001 à décembre 2010, nous avons examiné des patients ayant reçu un diagnostic de SDTB neurogène après une collision de véhicules motorisés. Nous avons coté le diagnostic principal selon les données objectives de notre examen physique.

Résultats : Au total, 263 patients ont reçu un diagnostic de SDTB neurogène durant la période à l’étude. Au degré le plus précis de diagnostic, 56 patients étaient atteints de syndrome canalaire du nerf cubital, 40, de syndrome du canal carpien et 55, de maladies non organiques, pour un total de 151 patients, ou 57,4 % des cas pour lesquels le diagnostic de SDTB neurogène avait été envisagé. La manoeuvre du chandelier (test de Roos) a reproduit les symptômes du syndrome canalaire du nerf cubital chez 33 des 56 patients atteints (58,9 %) et ceux du syndrome du canal carpien chez 18 des 40 patients atteints (45,0 %).

Conclusion : Il semble y avoir une forte incidence de mauvais diagnostics de SDTB neurogène après des collisions de véhicules motorisés. Le test de Roos n’est pas un test de premier choix pour ce syndrome.


Accepted for publication Apr. 28, 2016

Acknowledgements: The authors thank their teachers of anatomy at Western University, Ontario, and Kings College, London, without whom this paper would not have been possible, and Dr. W.R.E. Jamieson for helpful advice.

Affiliations: From the Department of Surgery, University of British Columbia, Retired (Munro); and the Department of Orthopedics, University of British Columbia, Retired (McPherson).

Competing interests: None declared.

Contributors: Both authors designed the study. A.I. Munro acquired and analyzed the data and wrote the article, which both authors reviewed and approved for publication.

DOI: 10.1503/cjs.009814

Correspondence to: A.I. Munro, PO BOX 62010, BPO Arbutus, BC, V6J 1Z1; munro3676@shaw.ca