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Relevance of bone anomalies in patients with thoracic outlet syndrome.
[thoracic outlet syndrome]
Skeletal
anomalies
are
recognized
as
potential
causes
of
thoracic
outlet
syndrome
(
TOS
)
;
however
,
there
is
a
paucity
of
information
regarding
the
specific
bone
anomalies
associated
with
TOS
and
their
relative
incidence
among
the
different
clinical
types
of
TOS
.
This
study
describes
the
prevalence
of
bone
anomalies
in
a
population
with
TOS
.
A
retrospective
chart
review
of
the
clinical
records
and
imaging
studies
of
all
patients
who
were
surgically
treated
at
our
institution
for
TOS
between
1991
-
2011
was
conducted
.
A
descriptive
analysis
of
the
cohort
of
patients
with
associated
bone
anomalies
was
performed
and
compared
with
the
cohort
of
patients
without
bone
anomalies
.
During
the
study
period
,
400
patients
underwent
operative
procedures
for
TOS
.
Of
these
,
115
(
29
%
)
harbored
a
bone
anomaly
and
the
remaining
285
did
not
.
The
bone
anomalies
included
80
(
69
%
)
cervical
ribs
,
25
(
22
%
)
clavicular
anomalies
,
and
10
(
9
%
)
isolated
first
rib
aberrations
.
Ninety
(
78
%
)
of
the
bone
anomalies
were
congenital
,
while
25
(
22
%
)
were
posttraumatic
.
The
bone
anomaly
cohort
was
predominantly
female
(
76
%
)
,
with
an
average
age
of
36
years
.
The
distribution
of
neurogenic
,
arterial
,
and
venous
types
of
TOS
in
the
cohort
with
bone
anomalies
was
63
%
,
33
%
,
and
4
%
,
respectively
,
while
it
was
51
%
neurogenic
,
11
%
arterial
,
and
38
%
venous
in
the
cohort
without
bone
anomalies
.
These
distributions
were
significantly
different
(
chi
-squared
:
56
.
75
;
P
<
0
.
0001
)
.
The
likelihood
of
neurogenic
compression
was
roughly
equivalent
between
the
2
cohorts
(
odds
ratio
[
OR
]
:
1
.
6
;
P
=
0
.
03
)
,
while
the
likelihood
of
arterial
compression
was
much
higher
in
the
presence
of
a
bone
anomaly
(
OR
:
4
.
0
;
P
<
0
.
001
)
and
the
likelihood
of
venous
compression
was
much
lower
in
the
presence
of
bone
anomaly
(
OR
:
0
.
07
;
P
<
0
.
001
)
.
Conversely
,
33
%
of
all
neurogenic
TOS
cases
,
54
%
of
all
arterial
TOS
cases
,
and
4
%
of
all
venous
TOS
cases
were
associated
with
a
bone
anomaly
.
In
our
experience
,
the
incidence
of
bone
anomalies
among
patients
treated
for
TOS
was
29
%
,
which
is
higher
than
previously
reported
.
Cervical
ribs
were
present
in
20
%
of
our
patients
with
TOS
,
an
estimated
40
times
higher
prevalence
than
that
in
the
general
population
.
However
,
acquired
clavicular
deformities
and
isolated
abnormal
first
ribs
were
found
in
9
%
of
our
patients
,
accounting
for
almost
one
-
third
of
all
bone
anomalies
present
in
this
TOS
population
.
The
incidence
of
bone
anomalies
is
rather
different
among
the
subtypes
of
TOS
.
The
strongest
association
with
the
presence
of
a
bone
anomaly
occurs
in
patients
with
arterial
TOS
,
although
46
%
of
all
our
arterial
TOS
cases
did
not
have
a
bone
anomaly
.
The
presence
of
bone
anomalies
does
not
seem
to
influence
the
occurrence
of
neurogenic
TOS
,
while
venous
TOS
likely
has
no
association
with
congenital
bone
anomalies
,
but
occasionally
mid
and
medial
clavicular
fracture
calluses
may
cause
venous
TOS
.
Diseases
Validation
Diseases presenting
"roughly equivalent"
symptom
thoracic outlet syndrome
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