Date: 17 Nov 93 22:27:32 GMT From: jzisfein@nymc.edu (Jim Zisfein) Subject: Re: thoracic syndrome Organization: Performance Systems Int'l Newsgroups: sci.med,sci.med.occupational Nntp-Software: PC/TCP NNTP In article <93320.111757SWHITE@UMAB.BITNET> SWHITE@UMAB.BITNET writes: > I have been diagnosed after 7 years of pain, with thoracic syndrome. My doc tor > did not diagnose this, she just recommended me for PT because the pain > was getting to be a nuisance (i.e. interfering with everyday activities). T he > physical therapist treating me gives me answers to specific questions, but I > would like a more comprehensive explanation as to causes, identifying sympt oms, > treatments and "cure" rates. References to further reading would also be > appreciated. Thanks in advance, Susan No such entity, at least that I'm aware of (I'm a neurologist, not a chest physician). Perhaps you mean "thoracic outlet syndrome"? If the latter, it is a term used by different physicians for wildly different things: 1. Neurogenic TOS: A rare entity manifested by gradually progressive weakness and atrophy, usually painless, of hand muscles (median and ulnar nerve innervated), usually on one side, usually painless (or at least pain is not the predominant complaint), with numbness on the ulnar side of the hand and forearm, and caused by cervical rib or other bony or fibrous structures impinging on the lower trunk or medial cord of the brachial plexus. 2. Vascular TOS: Another rare entity of vascular insufficiency in the arm caused by chronic constriction of the subclavian or axillary artery by bony or fibrous structures, diagnosed by markedly lower blood pressure in the affected arm, symptoms of claudication, sometimes gangrene of the hand. 3. "Disputed" TOS: If your symptoms are pains in the shoulder and arm with pain and/or paresthesias going into the hand, without any abnormalities on neurologic or EMG exam, you may have been diagnosed with this condition. It's called "disputed" because there is no evidence of brachial plexus pathology and there is little if any relationship to the above conditions. For further reading, check out Cherington et al, Muscle and Nerve 1986;9:632-634. Therapies are discussed there, including the decidedly *harmful* surgical therapy for "disputed" TOS. --- E-mail to: jzisfein@nymc.edu (Jim Zisfein) or to: jim.zisfein@factory.com (Jim Zisfein)