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.
---
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