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Dynamic neuromusculoskeletal ultrasound documentation of brachial plexus/thoracic outlet compression during elevated arm stress testing.
[thoracic outlet syndrome]
The
diagnosis
and
validation
of
thoracic
outlet
syndrome
/
brachial
plexopathy
(
TOS
)
remains
a
difficult
challenge
for
surgeons
,
neurologists
,
and
radiologists
.
This
is
due
to
the
fact
that
the
responses
of
standard
elevated
arm
stress
tests
can
be
considered
somewhat
subjective
and
can
vary
.
Therefore
,
non-
vascular
TOS
cases
are
presently
diagnosed
clinically
,
and
any
objective
diagnosis
has
been
controversial
.
This
is
a
technique
paper
describing
the
use
of
dynamic
neuromusculoskeletal
ultrasound
to
assist
in
the
diagnosis
of
thoracic
outlet
/
brachial
plexus
pathology
.
We
propose
a
new
way
to
observe
the
brachial
plexus
dynamically
,
so
that
physical
verification
of
nerve
compression
between
the
anterior
and
middle
scalene
muscles
can
be
clearly
made
at
the
onset
of
clinical
symptoms
.
This
gives
a
way
to
objectively
identify
clinically
significant
brachial
plexus
compression
.
Dynamic
testing
can
add
objective
analysis
to
tests
such
as
the
elevated
arm
stress
tests
and
can
correlate
the
onset
of
symptoms
with
plexus
compression
between
the
anterior
and
middle
scalene
muscles
.
With
this
,
the
area
of
pathologic
compression
can
be
identified
and
viewed
while
performing
the
dynamic
testing
.
If
compression
is
seen
and
the
onset
of
symptoms
ensues
,
this
is
a
positive
confirmatory
test
for
the
presence
of
TOS
and
a
clinically
significant
disease
.
This
paper
offers
a
simple
,
objective
,
and
visual
diagnostic
test
that
can
validate
the
presence
or
absence
of
brachial
plexus
compression
during
arm
elevation
in
patients
with
brachial
plexus
injury
and
thoracic
outlet
syndrome
.
Diseases
Validation
Diseases presenting
"clinically significant brachial"
symptom
thoracic outlet syndrome
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