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Retos en el manejo del síndrome de salida torácica
Challenges in the treatment of thoracic outlet syndrome.
Thoracic outlet syndrome (TOS) represents a group of heterogeneous and potentially disabling upper-extremity disorders that are caused by extrinsic compression of neurovascular structures between the first rib and clavicle. There are 3 distinct types of TOS, which are classified according to the principal anatomic structures involved and the clinical syndromes that result: neurogenic TOS, venous TOS, and arterial TOS. All 3 forms of TOS are rare, but they are clinically important because, when unrecognized or inadequately treated, they can cause chronic pain syndromes, long-term restrictions in use of the upper extremities, limb-threatening complications, and substantial disability even in relatively young, active, and otherwise healthy individuals. Accurate diagnosis of TOS can be a substantial challenge in practice, because of a lack of physician awareness, clinical features that overlap or mimic more common conditions, and an absence of clearly defined (objective) diagnostic criteria. There is also persistent controversy regarding the efficacy of the various treatment approaches for TOS-approaches that vary in accordance with the experience, expertise, and specialty of the physician. The purpose of this presentation is to briefly review current protocols for the diagnosis and treatment of TOS and to highlight the clinical-management challenges that remain.
KEYWORDS: Aneurysm/etiology; anticoagulants/therapeutic use; brachial plexus; effort thrombosis; embolism/etiology/therapy; subclavian artery aneurysm; subclavian vein; surgical treatment; thoracic outlet syndrome/diagnosis/etiology/surgery/therapy; thrombolytic therapy; upper extremity/blood supply; venous thrombosis/surgery/therapy
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Síndrome de la salida torácica neurogénica. Revisión etiopatológica. Serie de casos
Rafael Reynoso Campo
Ortho-tips Vol. 8 No. 1 2012
Resumen
La defi nición de salida torácica (SST) se establece al espacio virtual en forma de embudo, que conduce las estructuras nerviosas y vasculares en su camino hacia la extremidad superior. La incidencia de una costilla cervical parcial o total es de hasta 1% en la población, pero sólo desarrollan síntomas 10% de estos casos. El SST se presenta en mujeres 3 veces más que en hombres, en el rango entre los 30 a 45 años principalmente. El espectro semioló- gico fundamentalmente es neuropático y no vascular como tal, la estructuración de los signos y síntomas se consolida durante un periodo largo de tiempo de 2 y medio años promedio. La irradiación dolorosa típica de la salida torácica, conocida también como neuralgia cervicobraquial es el primero de sus síntomas cardinales y depende de la estructura nerviosa comprimida. Para hacer el diagnóstico se debe registrar la progresión de los síntomas no basta para ser concluyente en el diagnóstico, el cual requiere descartar otras patologías. La presencia de costilla cervical parcial y/o mega apófi sis transversa C7 se asocia a variantes musculares o bandas constrictivas. El tratamiento inicia con rehabilitación mientras se afi anza el diagnóstico (relajantes musculares, relajación de la masa de escalenos, deslizamiento del plexo braquial, ultrasonido, calor, fortalecimiento de musculatura interescapular, AINES). Los 53 pacientes de la serie quirúrgica fueron inter venidos debido a pobre respuesta al manejo de rehabilitación y alteración importante de sus actividades cotidianas y laborales.
Palabras clave: Salida torácica, costilla cervical, neuralgia, mano, síndrome
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Tratamiento del síndrome de salida torácica en pediatría
Managing pediatric thoracic outlet syndrome.
Rehemutula A1,2,3, Zhang L4,5,6, Chen L7,8,9, Chen D10,11,12, Gu Y13,14,15.
Abstract
BACKGROUND: Thoracic outlet syndrome (TOS) is largely overlooked in children and adolescents because the condition is not widely viewed as a pediatric disorder. This study aimed to clarify the causes, best treatment approaches, and prognosis for young patients with TOS. METHODS: A retrospective study was conducted on 13 patients, from 4 to 13 years of age, with TOS. Ten children underwent surgical treatment, and three were treated conservatively. All patients received local nerve blocks on two occasions and were followed-up for more than 2 years. RESULTS: Among the 10 children who underwent surgery, six school-aged children returned to school 10 to 14 days after surgery. Parents of the three children treated conservatively reported that activity within the affected limb and overall muscle strength had increased in their children and none of the three children had complained about discomfort in the affected limb.
CONCLUSION: A diagnosis of TOS should be considered when a child or adolescent has neck and shoulder discomfort, hand numbness, and upper limb weakness. As with adults with TOS, detailed physical examination is the key to diagnosing pediatric TOS. Conservative treatment is effective for young TOS patients who have mild changes in the length and thickness of the affected limb and is an option when parents refuse surgical treatment.
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Curso Internacional de Actualidades en Anestesiología
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Cuidad de México, Febrero 9-11, 2017
Informes ceddem_innsz@yahoo.com
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Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA)
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México
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Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
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California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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