Thoracic outlet syndrome.

OZET Torasik outlet sendromu Torasik outlet sendromu (TOS), klinik ozellikleri itibari ile fizik tedavi, ar› tedavisi, ortopedi, beyin cerrahisi, ic hastal›klar› gibi bircok disiplini birlikte ilgilendiren bir sendromdur. Etiyolojide s›kl›kla brakial pleksus ve ilgili yap›lar›n servikal bolgeden afla¤› doru seyirleri s›ras›nda interskalen ucgen, kostaklavikular ucgen ya da subkorakoid bolgede s›k›flmalar› bulunmaktad›r. Bu s›k›flma ya da entrapman servikal kotlardan, belirgin C7 transvers c›k›nt›s› varl›¤›ndan, daha s›kl›kla da ilgili alanda bulunan fibroz bantlardan oluflmaktad›r. Hastalar genellikle skapuladan ust ekstremiteye yay›lan ar›, uyuflma hissi, kimi zaman renk deifliklii ile baflvururlar. S›kl›kla kad›nlarda ve 20-50 yafllar aras›nda gorulur. Semptomlar a¤›r tafl›mak, kollar› kald›rmak ile artmaktad›r. Tan› ve tedavi ac›s›ndan norolojik semptomlar›n hakim olduu norojen TOS, vaskuler semptomlar›n on planda olduu vaskuler TOS ve her iki grubu tam olarak yans›tmayan non-spesifik TOS diye ay›rmak yararl› olmaktad›r. Tan›ya klinik muayene, provokatif testler, ultrasonografi; gerekli durumlarda Doppler ultrasonografi, anjiyografi, manyetik rezonans goruntuleme ile ulafl›lmaktad›r. Konservatif tedavi yeterli olmad›¤›nda ise cerrahi tedavi uygulan›r. Anahtar kelimeler: Torasik outlet sendromu, entrapman sendromlar›, ust ekstremite ar›s› SUMMARY Diagnosis and treatment of thoracic outlet syndrome (TOS) involves neurologists, physiatrists, family physicians, orthopedic surgeons, vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists. It is generally accepted that TOS is caused by compression of brachial plexus elements or subclavian vessels in their passage from the cervical area toward the axilla and proximal arm either at the interscalene triangle, the costoclavicular triangle, or the subcoracoid space. Cervical ribs, anomalous muscles, and fibrous bands may further constrict these areas. Patients with thoracic outlet syndrome usually have aching type pain radiating from their scapula down the upper extremity. It is more common in women, and between 20 and 50 years of age. In order to diagnose accurately, clinical presentation may be evaluated as neurogenic TOS, those with compression of the brachial plexus, or vascular TOS, those with compression of the subclavian vessels and nonspecific-type TOS. The diagnosis of TOS can be made by history, physical examination, provocative tests, ultrasound, radiological evaluation and electrodiagnostic evaluation. For most patients with TOS, conservative treatment is offered. Definitive treatment involves surgical decompression of the related structures.