흉곽출구증후군에서 전기진단학적 유용성
Significance of electrodiagnostic study in patients with classical thoracic outlet syndrome
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Objectives: To investigate the relationship between the findings of the electrodiagnostic study (EDX) and clinical evaluation in patients with classical thoracic outlet syndrome (TOS). Methods: Retrospective medical record review was done in 49 patients (age 46.7±15.1 years, 19 men) with clinically suspected TOS, referred for EDX from October 2003 to March 2010. EDXs were performed at 24.1±33.7 months from symptom onset. Ulnar and median, sensory and motor nerve conduction studies (NCS) were done in all patients and the medial antebrachial cutaneous nerve (MAC) NCS was done in 27 patients. Needle electromyography (EMG) was conducted in all subjects, covering at least one of those muscle-abductor pollicis brevis (APB), first dorsal interossei (FDI), abductor digiti minimi (ADM) and C8 paraspinal muscles. Results: 10 patients were diagnosed with classical TOS. Paresthesia was most common symptom. Hyperabduction test(80%) and Adson's test(71.4%) were sensitive provocation test. In radiologic study, CT and MRI was more sensitive(57.1%) than simple X-ray(40%). In EMG study, MAC NCS and FDI, ADM, APB, EIP(extensor indicis proprius) needle EMG were sensitive. Conclusion: The most sensitive EDX to detect TOS was MAC NCS. Paresthesia was the most common symptom, Hyperabduction test and Adson’s test were effective provocation tests.
Abstract
Objectives: To investigate the relationship between the findings of the electrodiagnostic study (EDX) and clinical evaluation in patients with classical thoracic outlet syndrome (TOS). Methods: Retrospective medical record review was done in 49 patients (age 46.7±15.1 years, 19 men) with clinically suspected TOS, referred for EDX from October 2003 to March 2010. EDXs were performed at 24.1±33.7 months from symptom onset. Ulnar and median, sensory and motor nerve conduction studies (NCS) were done in all patients and the medial antebrachial cutaneous nerve (MAC) NCS was done in 27 patients. Needle electromyography (EMG) was conducted in all subjects, covering at least one of those muscle-abductor pollicis brevis (APB), first dorsal interossei (FDI), abductor digiti minimi (ADM) and C8 paraspinal muscles. Results: 10 patients were diagnosed with classical TOS. Paresthesia was most common symptom. Hyperabduction test(80%) and Adson's test(71.4%) were sensitive provocation test. In radiologic study, CT and MRI was more sensitive(57.1%) than simple X-ray(40%). In EMG study, MAC NCS and FDI, ADM, APB, EIP(extensor indicis proprius) needle EMG were sensitive. Conclusion: The most sensitive EDX to detect TOS was MAC NCS. Paresthesia was the most common symptom, Hyperabduction test and Adson’s test were effective provocation tests.
참고문헌 (17)
- Sanders RJ, "Diagnosis of thoracic outlet syndrome", J Vasc Surg, 46, pp.601~604 (2007)
- Sanders RJ, "Thoracic Outlet Syndrome", The Neurologist, 14, pp.365~373 (2008)
- Cuetter AC, "The thoracic outlet syndrome: controversies, overdiagnosis, overtreatment, and recommendations for management", Muscle Nerve, 12, pp.410~419 (1989)
- Roos DB, "Thoracic outlet syndrome is underdiagnosed", Muscle Nerve, 22, pp.126~129 (1999)
- Park BK, "Thoracic outlet syndrome : wasting of the hand associated with neurofibroma", J Korean Acad Rehab Med, 15, pp.95~100 (1991)
- 신용범, "A형 보툴리눔독소를 이용한 흉곽출구증후군의 치료 1례 -증례보고-", Annals of Rehabilitation Medicine, 32(1), pp.119~121 (2008), 대한재활의학회
- Dumitru D, "Electrodiagnostic Medicine, 2nd ed", pp.817~820 (2002), Hanley & belfus
- Sanders R, "Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome", J Vasc Surg, 36, pp.51~56 (2002)
- Pang D, "Thoracic outlet syndrome", Neurosurgery, 22, pp.105~121 (1988)
- Swift TR, "The droopy shoulder syndrome", Neurology, 34, pp.212~215 (1984)
- Clein LJ, "The droopy shoulder syndrome", Can Med Assoc J, 114, pp.343~344 (1976)
- Huang JH, "Thoracic outlet syndrome", Neurosurgery, 55, pp.897~902 (2004)
- Rayan GM, "Thoracic outlet syndrome: provocative examination maneuvers in a typical population", J Shoulder Elbow Surg, 4, pp.113~117 (1995)
- Gillard J, "Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients", Joint Bone Spine, 68, pp.416~424 (2001)
- Sanders RJ, "Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome", J Vasc Surg, 36, pp.51~56 (2002)
- Seror P, "Medial antebrachial cutaneous nerve conduction study, a new tool to demonstrate mild lower brachial plexus lesions. A report of 16 cases", Clin Neurophysiol, 115, pp.2316~2322 (2004)
- Kothari MJ, "Medial antebrachial cutaneous sensory studies in the evaluation of neurogenic thoracic outlet syndrome", Muscle Nerve, 21, pp.647~649 (1998)